Provider Demographics
NPI:1700208881
Name:HEALTH SMART WEIGHT LOSS, LLC
Entity Type:Organization
Organization Name:HEALTH SMART WEIGHT LOSS, LLC
Other - Org Name:HEALTH SMART WEIGHT LOSS & GYNECOLOGY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:TAPIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-333-1614
Mailing Address - Street 1:600 MEDICAL DR STE 216
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3426
Mailing Address - Country:US
Mailing Address - Phone:314-603-7332
Mailing Address - Fax:
Practice Address - Street 1:600 MEDICAL DR STE 216
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3426
Practice Address - Country:US
Practice Address - Phone:314-603-7332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100712207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206884330Medicaid