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General NPI Number Information
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NPI Number | 1962299495
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Entity Type | Organization
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Legal Business Name | HEALTHSPAN DIRECT PRIMARY CARE LLC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 1000 CENTRAL ST
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City | LA BELLE
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State | MO
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Zip | 63447-2092
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Country | US
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Telephone | 660-213-3245
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 CENTRAL ST
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City | LA BELLE
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State | MO
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Zip | 63447-2092
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Country | US
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Telephone | 660-213-3245
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Fax | 660-243-0882
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. AARON NEISEN
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Credential | DO
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Telephone | 217-242-9966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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