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General NPI Number Information
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NPI Number | 1033511001
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Entity Type | Organization
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Legal Business Name | MEDICAL WEIGHT LOSS CENTERS LLC
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 12205 DORSETT RD
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-2407
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Country | US
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Telephone | 314-755-1555
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Fax | 314-755-1558
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Provider Business Mailing Address
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Address Line | 12205 DORSETT RD
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-2407
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Country | US
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Telephone | 314-755-1555
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Fax | 314-755-1558
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Authorized Official
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Title or Position | OWNER
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Name | JAMES A BRIGGS
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Credential | DC
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Telephone | 314-755-1555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | LC13060502
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License Number State | MO
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