Provider Demographics
NPI:1780930149
Name:SARASOTA WELLNESS AND WEIGHT MANAGEMENT LLC
Entity type:Organization
Organization Name:SARASOTA WELLNESS AND WEIGHT MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-388-7457
Mailing Address - Street 1:8588 POTTER PARK DR
Mailing Address - Street 2:ST 201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5471
Mailing Address - Country:US
Mailing Address - Phone:941-388-7457
Mailing Address - Fax:941-256-3305
Practice Address - Street 1:8588 POTTER PARK DR
Practice Address - Street 2:ST 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5471
Practice Address - Country:US
Practice Address - Phone:941-388-7457
Practice Address - Fax:941-256-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL70754261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service