Provider Demographics
NPI:1215383153
Name:SOUTHWEST WEIGHTLOSS, LLC
Entity Type:Organization
Organization Name:SOUTHWEST WEIGHTLOSS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-500-5080
Mailing Address - Street 1:9377 E BELL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1502
Mailing Address - Country:US
Mailing Address - Phone:480-500-5080
Mailing Address - Fax:480-500-5081
Practice Address - Street 1:9377 E BELL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1502
Practice Address - Country:US
Practice Address - Phone:480-500-5080
Practice Address - Fax:480-500-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21784208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty