Basic Information
Provider Information
NPI: 1982785838
EntityType: 2
ReplacementNPI:  
OrganizationName: CINCINNATI WEIGHT LOSS CENTER, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: SYNCHRONY HEALTH, LLC
OtherOrganizationType: 4
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9075 CENTRE POINTE DR
Address2: SUITE 160
City: WEST CHESTER
State: OH
PostalCode: 450694890
CountryCode: US
TelephoneNumber: 5139392263
FaxNumber: 5138744579
Practice Location
Address1: 9075 CENTRE POINTE DR
Address2: SUITE 160
City: WEST CHESTER
State: OH
PostalCode: 450694890
CountryCode: US
TelephoneNumber: 5139392263
FaxNumber: 5138744579
Other Information
ProviderEnumerationDate: 10/18/2006
LastUpdateDate: 01/23/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WATKINS
AuthorizedOfficialFirstName: BRADLEY
AuthorizedOfficialMiddleName: M
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 5139392263
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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