Provider Demographics
NPI:1417133000
Name:FOUNDATION WEIGHTWISE SERVICES, LLC
Entity Type:Organization
Organization Name:FOUNDATION WEIGHTWISE SERVICES, LLC
Other - Org Name:WEIGHTWISE AT SONTERRA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT COO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MORTON
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-608-1700
Mailing Address - Street 1:1202 E SONTERRA BLVD
Mailing Address - Street 2:STE 601
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4089
Mailing Address - Country:US
Mailing Address - Phone:210-499-6500
Mailing Address - Fax:210-499-6571
Practice Address - Street 1:1202 E SONTERRA BLVD
Practice Address - Street 2:STE 601
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4089
Practice Address - Country:US
Practice Address - Phone:210-499-6500
Practice Address - Fax:210-499-6571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty