Provider Demographics
NPI:1225042203
Name:FOOTHILLS BARIATRIC AND WELLNESS CENTER
Entity Type:Organization
Organization Name:FOOTHILLS BARIATRIC AND WELLNESS CENTER
Other - Org Name:FOOTHILLS BARIATRIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-855-0336
Mailing Address - Street 1:5284 CALHOUN MEMORIAL HWY
Mailing Address - Street 2:SUITE K
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3526
Mailing Address - Country:US
Mailing Address - Phone:864-855-0336
Mailing Address - Fax:864-855-0643
Practice Address - Street 1:5284 CALHOUN MEMORIAL HWY STE K
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3886
Practice Address - Country:US
Practice Address - Phone:864-855-0336
Practice Address - Fax:864-855-0643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
SC207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty