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General NPI Number Information
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NPI Number | 1891743662
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Entity Type | Organization
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Legal Business Name | HEALTHSPOT, LLC
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 420 W 2ND ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2414
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Country | US
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Telephone | 812-323-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 420 W 2ND ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2414
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Country | US
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Telephone | 812-323-9800
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KEVIN LEE LETZ
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Credential | ND, NP
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Telephone | 260-818-2128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01029905A
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License Number State | IN
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