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General NPI Number Information
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NPI Number | 1144124918
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Entity Type | Organization
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Legal Business Name | OURHEALTH PROFESSIONAL PHYSICIAN GROUP, LLC
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 800 HOMESTEAD DR
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City | NEW HAVEN
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State | IN
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Zip | 46774-1383
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Country | US
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Telephone | 260-322-4203
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1433
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City | PORTSMOUTH
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State | NH
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Zip | 03802-1433
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CENTRAL SUPPORT
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Name | KARLA SPIVEY
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Credential |
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Telephone | 866-434-3255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | NULL
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