MEDICARE: OURHEALTH PHYSICIANS GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1386190254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OURHEALTH PHYSICIANS GROUP, LLC

Provider Business Mailing Address
First Line	:	1 AMERICAN SQ
Second Line	:	2610
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46282-0020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5630 W 86TH ST
Second Line	:	SUITE 150
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-2017
Country	:	US
Telephone Number	:	317-559-2055
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFERY WELLS
Credential	:
Telephone Number	:	317-559-2055

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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