| Organization Name: | WEIGHT LOSS CLINIC, LLC |
| NPI Number: | 1962740589 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SARA LEE ANN CASSIDY (MANAGER) |
| Mailing Address: | 555 Marshall Dr Saint Robert |
| State: | MO US |
| Postal Code: | 655845601 |
| Phone Number: | 5733368746 |
| Fax Number: | 5733368391 |
| NPI Enumeration Date: | 01/17/2013 |
| NPI Last Update Date: | 01/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |