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General NPI Number Information
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NPI Number | 1518205947
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Entity Type | Organization
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Legal Business Name | ADVANCED WEIGHT LOSS CLINIC, L.L.C.
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 6809 STATE HIGHWAY 14 W
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City | CLEVER
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State | MO
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Zip | 65631-6799
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Country | US
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Telephone | 417-743-5113
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Fax | 417-743-5113
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Provider Business Mailing Address
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Address Line | 6809 SOUTH STATE HWY 14
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City | CLEVER
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State | MO
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Zip | 65631
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Country | US
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Telephone | 417-743-5113
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Fax | 417-743-5113
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Authorized Official
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Title or Position | PROFFESSIONAL
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Name | BRITTANY HALEY
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Credential |
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Telephone | 417-743-5113
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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 |
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License Number State |
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