180 Health Lifestyle Wellness Centers
Organization Active NPI General Practice Physician · Springfield, MO
NPI 1649815796 · NPPES record last updated Jul 28, 2020
Key facts
- NPI
- 1649815796
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- Legal business name
- 180 HEALTH LIFESTYLE WELLNESS CENTERS
- Practice address
- 1936 S Glenstone Ave
Springfield, MO 65804-2305 - Phone
- (417) 827-0450
- NPI assigned
- Nov 13, 2019
- Organization subpart
- No
Authorized official
- Name
- Tara Meek
- Title
- Owner
- Phone
- (417) 887-0340
Other NPIs on the same Medicare enrollment 1
Practitioners 10
-
Gary L Meek, DC
-
Jeffrey D. Steinle, D.C.
-
Devin Bell, D.O.
-
Preston Burgess, DC
-
Anjuli Ellis, FNP
-
Rebecca Lee Pearson, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200214000060 | MO | Part B Supplier - Clinic/Group Practice | 1052747888 |
Receives reassigned benefits from 7 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Springfield, MO |
| O20200417001960 | MO | DME Supplier - Multi-Specialty - Physician | 1052747888 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Springfield, MO |
National Provider Directory
Locations
500 E Battlefield St
Springfield, MO 65807
Phone (417) 887-0340
1936 S Glenstone Ave
Springfield, MO 65804
Phone (417) 827-0450
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| General Practice Physician |
208D00000X | Yes |
Addresses
Primary practice location
1936 S Glenstone Ave
Springfield, MO 65804-2305
Mailing address
1936 S Glenstone Ave
Springfield, MO 65804-2305
Phone (417) 827-0450
Other names
- 180 Health Medical and Wellness Center
Other providers in Springfield, MO
- 'Our House' Foundation
- 180 Health Lifestyle Wellness Centers
- 2Gethertech, LLC
- 360 Degrees Mobility Solutions
- 3B DDS LLC
- 417 Health & Wellness
All providers in Springfield, MO · General Practice Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.