MEDICARE: PROCARE HEALTHSPOT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1800X	Corporate Health Clinic/Center

General Provider Information

NPI Number	:	1245714500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCARE HEALTHSPOT, LLC

Provider Business Mailing Address
First Line	:	150 N ROSENBERGER AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47712-6503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4949 HEALTHY WAY
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-1180
Country	:	US
Telephone Number	:	812-491-3856
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	TAMMY FELDPAUSCH
Credential	:
Telephone Number	:	812-491-3856

Provider Enumeration Date	:	09/21/2018
Last Update Date	:	09/21/2018

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