Healthcare Provider Details

I. General information

NPI: 1649457482
Provider Name (Legal Business Name): THOMAS WEIGHT LOSS MANAGEMENT SYSTEM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12015 WHITMARSH LN
TAMPA FL
33626-1737
US

IV. Provider business mailing address

12015 WHITMARSH LN
TAMPA FL
33626-1737
US

V. Phone/Fax

Practice location:
  • Phone: 813-597-0202
  • Fax: 813-425-9043
Mailing address:
  • Phone: 813-597-0202
  • Fax: 813-425-9043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberME82489
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME82489
License Number StateFL

VIII. Authorized Official

Name: DR. STANLEY M THOMAS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 813-597-0202