=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043642036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEIGHT CONTROL OF TEXAS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2013
-----------------------------------------------------
Last Update Date | 08/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6051 FM 3009 STE 255
-----------------------------------------------------
City | SCHERTZ
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78154-3445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-651-1744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6051 FM 3009 STE 255
-----------------------------------------------------
City | SCHERTZ
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78154-3445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-651-1744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARY MYERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-651-1744
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------