Provider Demographics
NPI:1538703053
Name:QUEST FITNESS
Entity Type:Organization
Organization Name:QUEST FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-983-3337
Mailing Address - Street 1:1693 LAKEOVER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-8015
Mailing Address - Country:US
Mailing Address - Phone:601-982-7360
Mailing Address - Fax:
Practice Address - Street 1:1693 LAKEOVER RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-8015
Practice Address - Country:US
Practice Address - Phone:601-982-7360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEST FITNESS CLUB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health