Provider Demographics
NPI:1851544555
Name:VICTORY INSTITUTE FOR WEIGHT MANAGEMENT
Entity Type:Organization
Organization Name:VICTORY INSTITUTE FOR WEIGHT MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:616-457-3600
Mailing Address - Street 1:2093 HEALTH DR SW
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9691
Mailing Address - Country:US
Mailing Address - Phone:616-457-3600
Mailing Address - Fax:616-284-5208
Practice Address - Street 1:2093 HEALTH DR SW
Practice Address - Street 2:SUITE 302
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9691
Practice Address - Country:US
Practice Address - Phone:616-457-3600
Practice Address - Fax:616-284-5208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty