MEDICARE: OURHEALTH PROFESSIONAL PHYSICIAN GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1598615767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OURHEALTH PROFESSIONAL PHYSICIAN GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1433
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03802-1433
Country	:	US
Telephone Number	:	866-434-3255
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 INDUSTRIAL WAY
Second Line	:
City	:	CROTHERSVILLE
State	:	IN
Zip	:	47229-9415
Country	:	US
Telephone Number	:	812-793-2888
Fax Number	:

Authorized Official
Title or Position	:	CENTRAL SUPPORT SPECIALIST
Name	:	KARLA SPIVEY
Credential	:
Telephone Number	:	866-434-3255

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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