Provider Demographics
NPI:1689372880
Name:MEDLIFEFIT MEDICAL SPA INC
Entity Type:Organization
Organization Name:MEDLIFEFIT MEDICAL SPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-797-9656
Mailing Address - Street 1:1442 HORN ST STE A&B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-6701
Mailing Address - Country:US
Mailing Address - Phone:502-797-9686
Mailing Address - Fax:
Practice Address - Street 1:1442 HORN ST STE A&B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-6701
Practice Address - Country:US
Practice Address - Phone:812-924-7167
Practice Address - Fax:812-924-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265497499OtherNPI