Healthcare Provider Details

I. General information

NPI: 1417133000
Provider Name (Legal Business Name): FOUNDATION WEIGHTWISE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 E SONTERRA BLVD STE 601
SAN ANTONIO TX
78258-4089
US

IV. Provider business mailing address

1202 E SONTERRA BLVD STE 601
SAN ANTONIO TX
78258-4089
US

V. Phone/Fax

Practice location:
  • Phone: 210-499-6500
  • Fax: 210-499-6571
Mailing address:
  • Phone: 210-499-6500
  • Fax: 210-499-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MORTON BYERS
Title or Position: PRESIDENT COO
Credential:
Phone: 405-608-1700