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General NPI Number Information
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NPI Number | 1285875039
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Entity Type | Organization
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Legal Business Name | MEDSHAPE WEIGHT LOSS CLINIC LLC
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Dates
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Enumeration Date | 03/07/2009
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Last Update Date | 03/07/2009
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Provider Practice Location Address
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Address Line | 1845 S DOBSON RD 202
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City | MESA
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State | AZ
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Zip | 85202-5661
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Country | US
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Telephone | 480-413-9000
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Fax | 480-413-2060
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Provider Business Mailing Address
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Address Line | 1845 S DOBSON RD 202
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City | MESA
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State | AZ
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Zip | 85202-5661
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Country | US
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Telephone | 480-413-9000
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Fax | 480-413-2060
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MS. STEPANIE SMITH
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Credential |
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Telephone | 480-413-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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