Provider Demographics
NPI:1245267327
Name:CENTER FOR WEIGHT LOSS SURGERY PLLC
Entity type:Organization
Organization Name:CENTER FOR WEIGHT LOSS SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:SRIKANTH
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:253-815-7774
Mailing Address - Street 1:34509 9TH AVE. SOUTH
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8707
Mailing Address - Country:US
Mailing Address - Phone:253-815-7774
Mailing Address - Fax:253-815-7708
Practice Address - Street 1:34509 9TH AVE. SOUTH
Practice Address - Street 2:SUITE 103
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8707
Practice Address - Country:US
Practice Address - Phone:253-815-7774
Practice Address - Fax:253-815-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033726208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherTAX IDENTIFICATION (EIN)