Provider Demographics
NPI:1528602554
Name:SYNERGY 360 LLC
Entity Type:Organization
Organization Name:SYNERGY 360 LLC
Other - Org Name:ENERG HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR
Authorized Official - Phone:678-815-8776
Mailing Address - Street 1:3316 WEYBURN DRIVE
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084
Mailing Address - Country:US
Mailing Address - Phone:214-531-7880
Mailing Address - Fax:
Practice Address - Street 1:3316 WEYBURN DRIVE
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084
Practice Address - Country:US
Practice Address - Phone:214-531-7880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-02
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine