Provider Demographics
NPI:1558003475
Name:TRANSFORM WEIGHT LOSS LLC
Entity Type:Organization
Organization Name:TRANSFORM WEIGHT LOSS LLC
Other - Org Name:TRANSFORM ASC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BILLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-305-5182
Mailing Address - Street 1:19230 ALDERWOOD MALL PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4869
Mailing Address - Country:US
Mailing Address - Phone:425-305-5182
Mailing Address - Fax:253-214-3701
Practice Address - Street 1:21911 76TH AVE W STE 103
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7918
Practice Address - Country:US
Practice Address - Phone:425-305-5182
Practice Address - Fax:253-214-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty