Provider Demographics
NPI:1053616557
Name:SURGICAL WEIGHT LOSS SPECIALISTS LLC
Entity type:Organization
Organization Name:SURGICAL WEIGHT LOSS SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASGOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-668-4400
Mailing Address - Street 1:278 UNION ST
Mailing Address - Street 2:
Mailing Address - City:EAST WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02032-1037
Mailing Address - Country:US
Mailing Address - Phone:508-668-4400
Mailing Address - Fax:508-664-4420
Practice Address - Street 1:278 UNION ST
Practice Address - Street 2:
Practice Address - City:EAST WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02032-1037
Practice Address - Country:US
Practice Address - Phone:508-668-4400
Practice Address - Fax:508-668-4420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty