# WEIGHT LOSS CLINIC OF COLLEGE STATION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497127468
- **Authorized official:** MR. STEPHEN JOEL OREN (MANAGING MEMBER)
- **Authorized official phone:** (817) 271-4154

## Contact information

- **Practice address:** 1105 UNIVERSITY DR E, SUITE 100, COLLEGE STATION, TX 77840-2183
- **Practice address phone:** (979) 393-0369
- **Practice address fax:** (979) 446-0755
- **Mailing address:** 2050 SHADY OAKS DR, SOUTHLAKE, TX 76092-3510
- **Mailing address phone:** (817) 271-4154
- **Mailing address fax:** (817) 796-1595

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | J6399 | TX | Yes |

## Other

- **Enumeration date:** 10/29/2015
- **Last updated:** 05/20/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1669792321 | NPI | TX |
| 01 | — | 1740380923 | NPI | TX |
| 01 | — | 1790890259 | NPI | TX |
| 01 | — | 1851710347 | NPI | TX |