Healthcare Provider Details

I. General information

NPI: 1518394733
Provider Name (Legal Business Name): KEY PONTE MEDICAL WEIGHT LOSS & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 COOPER RD SUITE #8
MONTGOMERY OH
45242-7744
US

IV. Provider business mailing address

235 INDUSTRIAL DR
FRANKLIN OH
45005-4429
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-9474
  • Fax: 513-791-9475
Mailing address:
  • Phone: 937-743-9474
  • Fax: 937-743-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35058433
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number35058433
License Number StateOH

VIII. Authorized Official

Name: DR. WILLIAM LOVETT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 937-743-9474