Provider Demographics
NPI:1962299495
Name:HEALTHSPAN DIRECT PRIMARY CARE LLC
Entity type:Organization
Organization Name:HEALTHSPAN DIRECT PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:NEISEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:217-242-9966
Mailing Address - Street 1:1000 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:LA BELLE
Mailing Address - State:MO
Mailing Address - Zip Code:63447-2092
Mailing Address - Country:US
Mailing Address - Phone:660-213-3245
Mailing Address - Fax:660-243-0882
Practice Address - Street 1:1000 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:LA BELLE
Practice Address - State:MO
Practice Address - Zip Code:63447-2092
Practice Address - Country:US
Practice Address - Phone:660-213-3245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care