Provider Demographics
NPI:1932537230
Name:HORMONE HEALTH AND WEIGHT LOSS
Entity Type:Organization
Organization Name:HORMONE HEALTH AND WEIGHT LOSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CHASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-462-9561
Mailing Address - Street 1:6202 N 9TH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8293
Mailing Address - Country:US
Mailing Address - Phone:850-462-9561
Mailing Address - Fax:850-462-9560
Practice Address - Street 1:6202 N 9TH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8293
Practice Address - Country:US
Practice Address - Phone:850-462-9561
Practice Address - Fax:850-462-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service