Provider Demographics
NPI:1457755514
Name:SVELTE LLC
Entity Type:Organization
Organization Name:SVELTE LLC
Other - Org Name:FIT MEDICAL WEIGHT LOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:VARLEY
Authorized Official - Last Name:NYMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-400-3889
Mailing Address - Street 1:6344 E BROADWAY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1634
Mailing Address - Country:US
Mailing Address - Phone:480-832-0688
Mailing Address - Fax:
Practice Address - Street 1:6344 E BROADWAY RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1634
Practice Address - Country:US
Practice Address - Phone:480-832-0688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty