Healthcare Provider Details

I. General information

NPI: 1740147669
Provider Name (Legal Business Name): WELLNESS PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 S DURKIN DR
SPRINGFIELD IL
62704-1386
US

IV. Provider business mailing address

403 PIAZZA LN
CHATHAM IL
62629-5035
US

V. Phone/Fax

Practice location:
  • Phone: 773-316-1022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALICIA ALTHEIMER
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 773-316-1022