Provider Demographics
NPI:1659557130
Name:MEDICAL WEIGHT MANAGEMENT INC.
Entity Type:Organization
Organization Name:MEDICAL WEIGHT MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WINFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:406-442-9302
Mailing Address - Street 1:25 S EWING ST STE 521
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5753
Mailing Address - Country:US
Mailing Address - Phone:406-442-9302
Mailing Address - Fax:406-449-6154
Practice Address - Street 1:25 S EWING ST STE 521
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5753
Practice Address - Country:US
Practice Address - Phone:406-442-9302
Practice Address - Fax:406-449-6154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0800008494261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTDF8746OtherRAILROAD MEDICARE B
MT4304690Medicaid