Provider Demographics
NPI:1649457482
Name:THOMAS WEIGHT LOSS MANAGEMENT SYSTEM, LLC
Entity type:Organization
Organization Name:THOMAS WEIGHT LOSS MANAGEMENT SYSTEM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-597-0202
Mailing Address - Street 1:12015 WHITMARSH LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1737
Mailing Address - Country:US
Mailing Address - Phone:813-597-0202
Mailing Address - Fax:813-425-9043
Practice Address - Street 1:12015 WHITMARSH LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1737
Practice Address - Country:US
Practice Address - Phone:813-597-0202
Practice Address - Fax:813-425-9043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82489261QP2300X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04002OtherBCBS OF FLORIDA
FL222672OtherAMEDRIGROUP
FL263232200Medicaid
FLP00289057OtherRAILROAD MEDICARE
FL514769328OtherCHAMPUS
FLP00289057OtherRAILROAD MEDICARE
FL263232200Medicaid
FL04002YMedicare PIN
FL514769328OtherCHAMPUS