Provider Demographics
NPI:1518394733
Name:KEY PONTE MEDICAL WEIGHT LOSS & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:KEY PONTE MEDICAL WEIGHT LOSS & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-743-9474
Mailing Address - Street 1:235 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-4429
Mailing Address - Country:US
Mailing Address - Phone:937-743-9474
Mailing Address - Fax:937-743-9475
Practice Address - Street 1:7770 COOPER RD
Practice Address - Street 2:SUITE #8
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-7744
Practice Address - Country:US
Practice Address - Phone:513-791-9474
Practice Address - Fax:513-791-9475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEY POINTE MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058433207Q00000X, 207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE96125Medicare UPIN