Provider Demographics
NPI:1639591050
Name:ARIZONA LS, LLC
Entity Type:Organization
Organization Name:ARIZONA LS, LLC
Other - Org Name:MEDI-WEIGHTLOSS CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:DESPOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-228-6334
Mailing Address - Street 1:509 S HYDE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2266
Mailing Address - Country:US
Mailing Address - Phone:813-228-6334
Mailing Address - Fax:813-228-6763
Practice Address - Street 1:99 CHELMSFORD RD
Practice Address - Street 2:SUITE 8
Practice Address - City:NORTH BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01862-1350
Practice Address - Country:US
Practice Address - Phone:978-244-0411
Practice Address - Fax:978-362-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty