Provider Demographics
NPI:1841664208
Name:PARK CITIES WEIGHTLOSS CLINIC, LLC
Entity type:Organization
Organization Name:PARK CITIES WEIGHTLOSS CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:OREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-271-4154
Mailing Address - Street 1:2050 SHADY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3510
Mailing Address - Country:US
Mailing Address - Phone:817-271-4154
Mailing Address - Fax:817-697-1595
Practice Address - Street 1:6170 SHERRY LN
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6350
Practice Address - Country:US
Practice Address - Phone:214-253-0029
Practice Address - Fax:214-466-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1376654988OtherNPI
TX1215094933OtherNPI
TX1043277221OtherNPI
TX1740308923OtherNPI
TX1558612325OtherNPI
TX1194771006OtherNPI