| 515 Fitness Inc. | |
|
40 N Broadway St Coal City IL 60416-1688 | |
| (630) 352-7267 | |
| Not Available |
| Full Name | 515 Fitness Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 40 N Broadway St, Coal City, Illinois |
| Authorized Official Name and Position | Scott Carter (OFFICE MANAGER) |
| Authorized Official Contact | 6305909250 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 515 Fitness Inc. 40 N Broadway St Coal City IL 60416-1688 Ph: (630) 352-7267 | 515 Fitness Inc. 40 N Broadway St Coal City IL 60416-1688 Ph: (630) 352-7267 |
| NPI Number | 1134508310 |
|---|---|
| Provider Enumeration Date | 05/21/2015 |
| Last Update Date | 04/22/2020 |
| Certification Date | 04/22/2020 |
| Medicare PECOS PAC ID | 6103172341 |
|---|---|
| Medicare Enrollment ID | O20180702001423 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134508310 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 180.007735 (Illinois) | Primary |
| Provider Name | Nicole Perry |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083006563 PECOS PAC ID: 2163778309 Enrollment ID: I20240109000279 |
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