Provider Demographics
NPI:1679917553
Name:GE BARIATRIC & ANTI-AGING SOLUTIONS, LLC
Entity Type:Organization
Organization Name:GE BARIATRIC & ANTI-AGING SOLUTIONS, LLC
Other - Org Name:INSHAPEWV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC
Authorized Official - Phone:681-238-5258
Mailing Address - Street 1:956 N EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3114
Mailing Address - Country:US
Mailing Address - Phone:681-238-5258
Mailing Address - Fax:681-238-5700
Practice Address - Street 1:956 N EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3114
Practice Address - Country:US
Practice Address - Phone:681-238-5258
Practice Address - Fax:681-238-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV50904261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336604750OtherNPI-DANA FROBLE
1346599313OtherNPI-PAULA BRAMMER
1679917553OtherNPI-MERCEDES WEIKLE
1447237458OtherNPI-DR. ROGER EDWARDS