Healthcare Provider Details

I. General information

NPI: 1912824111
Provider Name (Legal Business Name): OURHEALTH PROFESSIONAL PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6448 W OHIO ST
INDIANAPOLIS IN
46214-3973
US

IV. Provider business mailing address

PO BOX 1433
PORTSMOUTH NH
03802-1433
US

V. Phone/Fax

Practice location:
  • Phone: 317-641-0551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARLA SPIVEY
Title or Position: CENTRAL SUPPORT SPECIALIST
Credential:
Phone: 866-434-3255