Provider Demographics
NPI:1588841316
Name:NEW LIFE BARIATRIC, PA
Entity Type:Organization
Organization Name:NEW LIFE BARIATRIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LU
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WELDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-381-1155
Mailing Address - Street 1:1911 PORT LN
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2470
Mailing Address - Country:US
Mailing Address - Phone:806-331-6293
Mailing Address - Fax:806-331-6295
Practice Address - Street 1:1911 PORT LN
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2470
Practice Address - Country:US
Practice Address - Phone:806-331-6293
Practice Address - Fax:806-331-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41702208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF25480Medicare UPIN