| Flourish Health Group In Llc | |
|
1160 Joliet St Ste 204 Dyer IN 46311-2096 | |
| (212) 300-7308 | |
| (212) 300-7308 |
| Full Name | Flourish Health Group In Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1160 Joliet St Ste 204, Dyer, Indiana |
| Authorized Official Name and Position | Alex Pavicevic (MANAGER) |
| Authorized Official Contact | 2123007308 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Flourish Health Group In Llc 1160 Joliet St Ste 204 Dyer IN 46311-2096 Ph: (212) 300-7308 | Flourish Health Group In Llc 1160 Joliet St Ste 204 Dyer IN 46311-2096 Ph: (212) 300-7308 |
| NPI Number | 1467168252 |
|---|---|
| Provider Enumeration Date | 01/25/2023 |
| Last Update Date | 04/25/2023 |
| Medicare PECOS PAC ID | 9537524988 |
|---|---|
| Medicare Enrollment ID | O20230508002231 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467168252 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Ashley B Obannon |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1629248711 PECOS PAC ID: 3870644982 Enrollment ID: I20120530000165 |
| Provider Name | Rena Frances Rivas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023675642 PECOS PAC ID: 6901268879 Enrollment ID: I20230810000441 |
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