Provider Demographics
NPI:1346075819
Name:INNOVATE MY WEIGHT
Entity type:Organization
Organization Name:INNOVATE MY WEIGHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'HERN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:515-443-0203
Mailing Address - Street 1:3160 8TH ST SW # G-106
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1023
Mailing Address - Country:US
Mailing Address - Phone:515-443-0203
Mailing Address - Fax:515-478-7253
Practice Address - Street 1:3160 8TH ST SW STE G-106
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1023
Practice Address - Country:US
Practice Address - Phone:515-443-0203
Practice Address - Fax:515-478-7253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service