Provider Demographics
NPI:1407232770
Name:SHORT PUMP WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:SHORT PUMP WELLNESS CLINIC, LLC
Other - Org Name:MEDI WEIGHTLOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:CURRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-717-5000
Mailing Address - Street 1:230 BROWNS WAY RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-9501
Mailing Address - Country:US
Mailing Address - Phone:804-419-9101
Mailing Address - Fax:
Practice Address - Street 1:11551 NUCKOLS RD
Practice Address - Street 2:SUITE C
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5565
Practice Address - Country:US
Practice Address - Phone:804-888-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty