Provider Demographics
NPI:1477928810
Name:NMS WEIGHTLOSS CLINIC II LLC
Entity Type:Organization
Organization Name:NMS WEIGHTLOSS CLINIC II LLC
Other - Org Name:MEDI WEIGHTLOSS CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-333-0828
Mailing Address - Street 1:6150 DIAMOND CENTRE COURT
Mailing Address - Street 2:BLDG #400
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912
Mailing Address - Country:US
Mailing Address - Phone:239-333-0828
Mailing Address - Fax:239-561-9188
Practice Address - Street 1:90 CYPRESS WAY E
Practice Address - Street 2:SUITE 45
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-9275
Practice Address - Country:US
Practice Address - Phone:239-325-1633
Practice Address - Fax:239-325-1630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL07000111368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty