Healthcare Provider Details

I. General information

NPI: 1558727719
Provider Name (Legal Business Name): OURHEALTH PHYSICIANS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 E MAIN ST 101
PLAINFIELD IN
46168-2759
US

IV. Provider business mailing address

4151 E 96TH ST
INDIANAPOLIS IN
46240-1442
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 Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JEFF WELLS
Title or Position: PRESIDENT
Credential:
Phone: 866-434-3255