Organization
FIT KIDZ OBESITY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES E KELLY (REGISTERED AGENT)
(765) 430-4710
Entity
Organization
Contact information
Practice address
2621 MAPLE POINT DR, LAFAYETTE, IN 47905-5159
(765) 430-4710
Mailing address
2621 MAPLE POINT DR, LAFAYETTE, IN 47905-5159
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
305S00000X
Point of Service
—
—
Other
Enumeration date
02/03/2010
Last updated
02/03/2010
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