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General NPI Number Information
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NPI Number | 1245394394
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Entity Type | Organization
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Legal Business Name | WEIGHT LOSS SURGERY CENTER
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 645 J CLYDE MORRIS BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1819
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Country | US
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Telephone | 757-591-9572
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Fax | 757-591-9606
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Provider Business Mailing Address
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Address Line | 645 J CLYDE MORRIS BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1819
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Country | US
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Telephone | 757-591-9572
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Fax | 757-591-9606
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHAWN JOYNER
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Credential |
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Telephone | 757-591-9572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101236493
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101050712
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License Number State | VA
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