Healthcare Provider Details

I. General information

NPI: 1609650662
Provider Name (Legal Business Name): OURHEALTH PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 E CARMEL DR STE 150
CARMEL IN
46032-2400
US

IV. Provider business mailing address

10 W MARKET ST STE 2900
INDIANAPOLIS IN
46204-2964
US

V. Phone/Fax

Practice location:
  • Phone: 866-434-3255
  • Fax:
Mailing address:
  • Phone: 866-434-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RHIANNON CHANDLER
Title or Position: LOGISTICS
Credential:
Phone: 866-434-3255