Provider Demographics
NPI:1730483140
Name:BURTON CREEK WEIGHT LOSS SOLUTIONS, LLC
Entity Type:Organization
Organization Name:BURTON CREEK WEIGHT LOSS SOLUTIONS, LLC
Other - Org Name:DBA BURTON CREEK MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:417-256-2111
Mailing Address - Street 1:805 N KENTUCKY AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2022
Mailing Address - Country:US
Mailing Address - Phone:417-256-2111
Mailing Address - Fax:417-256-4858
Practice Address - Street 1:709 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2085
Practice Address - Country:US
Practice Address - Phone:417-256-2111
Practice Address - Fax:417-256-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty