Healthcare Provider Details

I. General information

NPI: 1487120788
Provider Name (Legal Business Name): OURHEALTH PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11568 SPRINGFIELD PIKE
SPRINGDALE OH
45246-3527
US

IV. Provider business mailing address

4151 E 96TH ST
INDIANAPOLIS IN
46240-1442
US

V. Phone/Fax

Practice location:
  • Phone: 513-964-0830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFFREY MICHAEL WELLS
Title or Position: PRESIDENT
Credential:
Phone: 317-522-0823