Provider Demographics
NPI:1497150577
Name:AMAZING WEIGHT LOSS & WELLNESS
Entity Type:Organization
Organization Name:AMAZING WEIGHT LOSS & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-355-8363
Mailing Address - Street 1:3121 CROSS TIMBERS RD
Mailing Address - Street 2:STE 200
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2714
Mailing Address - Country:US
Mailing Address - Phone:972-355-8363
Mailing Address - Fax:
Practice Address - Street 1:3121 CROSS TIMBERS RD
Practice Address - Street 2:STE 200
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2714
Practice Address - Country:US
Practice Address - Phone:972-355-8363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty