MEDICARE: THOMAS WEIGHT LOSS MANAGEMENT SYSTEM, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	ME82489	FL
2	261QH0100X	Health Service Clinic/Center	ME82489	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00289057	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04002	OTHER	FL	BCBS OF FLORIDA
2	222672	OTHER	FL	AMEDRIGROUP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	514769328	OTHER	FL	CHAMPUS

General Provider Information

NPI Number	:	1649457482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS WEIGHT LOSS MANAGEMENT SYSTEM, LLC

Provider Business Mailing Address
First Line	:	12015 WHITMARSH LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1737
Country	:	US
Telephone Number	:	813-597-0202
Fax Number	:	813-425-9043

Provider Business Practice Location Address
First Line	:	12015 WHITMARSH LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1737
Country	:	US
Telephone Number	:	813-597-0202
Fax Number	:	813-425-9043

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. STANLEY M THOMAS
Credential	:	M.D.
Telephone Number	:	813-597-0202

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	01/27/2009

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