Provider Demographics
NPI:1174813711
Name:LEVEL ONE FOUNDATION INC
Entity Type:Organization
Organization Name:LEVEL ONE FOUNDATION INC
Other - Org Name:D AND S MEDICAL OF HOUSTON WEIGHT LOSS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DERWIN
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:BLACKSHEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-290-8075
Mailing Address - Street 1:3460 ELLA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-6135
Mailing Address - Country:US
Mailing Address - Phone:832-387-3918
Mailing Address - Fax:
Practice Address - Street 1:3460 ELLA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-6135
Practice Address - Country:US
Practice Address - Phone:832-387-3918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-16
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization