Provider Demographics
NPI:1154796126
Name:NMS WEIGHTLOSS CLINIC I LLC
Entity type:Organization
Organization Name:NMS WEIGHTLOSS CLINIC I LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-333-0828
Mailing Address - Street 1:6150 DIAMOND CENTRE CT
Mailing Address - Street 2:BLDG #400
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4368
Mailing Address - Country:US
Mailing Address - Phone:239-333-0828
Mailing Address - Fax:239-561-9188
Practice Address - Street 1:6150 DIAMOND CENTRE CT
Practice Address - Street 2:BLDG #400
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4368
Practice Address - Country:US
Practice Address - Phone:239-333-0828
Practice Address - Fax:239-561-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL06000097103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty