Provider Demographics
NPI:1376989830
Name:CLEARWATER WEIGHTLOSS, LLC
Entity Type:Organization
Organization Name:CLEARWATER WEIGHTLOSS, LLC
Other - Org Name:MEDI WEIGHTLOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZBELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-726-6338
Mailing Address - Street 1:2454 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1353
Mailing Address - Country:US
Mailing Address - Phone:727-726-6338
Mailing Address - Fax:727-796-8764
Practice Address - Street 1:2454 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 601
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1353
Practice Address - Country:US
Practice Address - Phone:727-726-6338
Practice Address - Fax:727-796-8764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 48354207VB0002X, 2083B0002X
FLME 71673207VB0002X, 2083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity MedicineGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 48354OtherLICENSE
FLME 71673OtherLICENSE
FLD20727OtherUPIN
FLG92346OtherUPIN
FL056917800Medicaid
FLD20727OtherUPIN
FLG92346OtherUPIN