Provider Demographics
NPI:1891743662
Name:HEALTHSPOT, LLC
Entity Type:Organization
Organization Name:HEALTHSPOT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LETZ
Authorized Official - Suffix:
Authorized Official - Credentials:ND, NP
Authorized Official - Phone:260-818-2128
Mailing Address - Street 1:420 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2414
Mailing Address - Country:US
Mailing Address - Phone:812-323-9800
Mailing Address - Fax:
Practice Address - Street 1:420 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2414
Practice Address - Country:US
Practice Address - Phone:812-323-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029905A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN234540Medicare ID - Type Unspecified