Provider Demographics
NPI:1659461879
Name:WEIGHT LOSS SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:WEIGHT LOSS SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:PALZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-940-1675
Mailing Address - Street 1:12850 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2622
Mailing Address - Country:US
Mailing Address - Phone:913-492-0160
Mailing Address - Fax:913-492-0154
Practice Address - Street 1:12850 METCALF AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2622
Practice Address - Country:US
Practice Address - Phone:913-492-0160
Practice Address - Fax:913-492-0154
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE VALLEY HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-16
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6057905208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty