Provider Demographics
NPI:1659725026
Name:FAITH BARIATRIC SUCCESS CLINIC
Entity Type:Organization
Organization Name:FAITH BARIATRIC SUCCESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-802-9993
Mailing Address - Street 1:3716 STANDRIDGE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4566
Mailing Address - Country:US
Mailing Address - Phone:469-910-4400
Mailing Address - Fax:469-440-8805
Practice Address - Street 1:3716 STANDRIDGE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-4566
Practice Address - Country:US
Practice Address - Phone:469-910-4400
Practice Address - Fax:469-440-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP106313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty