Provider Demographics
NPI:1245790724
Name:YOUR WEIGH WELLNESS CLINIC LLP
Entity type:Organization
Organization Name:YOUR WEIGH WELLNESS CLINIC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-899-2273
Mailing Address - Street 1:9405 US HIGHWAY 23 S STE 1
Mailing Address - Street 2:
Mailing Address - City:STANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41659-9048
Mailing Address - Country:US
Mailing Address - Phone:606-899-2273
Mailing Address - Fax:606-202-7252
Practice Address - Street 1:9405 US HIGHWAY 23 S STE 1
Practice Address - Street 2:
Practice Address - City:STANVILLE
Practice Address - State:KY
Practice Address - Zip Code:41659-9048
Practice Address - Country:US
Practice Address - Phone:606-899-2273
Practice Address - Fax:606-202-7252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty