Healthcare Provider Details

I. General information

NPI: 1174440549
Provider Name (Legal Business Name): 41 HEALTH COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 W HOOSIER BLVD
PERU IN
46970-3643
US

IV. Provider business mailing address

1870 W HOOSIER BLVD
PERU IN
46970-3643
US

V. Phone/Fax

Practice location:
  • Phone: 765-271-8414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSIE MYERS
Title or Position: NP/MANAGING MEMBER
Credential: NP
Phone: 765-271-8414