MEDICARE: OURHEALTH PHYSICIAN 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	:	1518209782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OURHEALTH PHYSICIAN GROUP, LLC

Provider Business Mailing Address
First Line	:	10 W MARKET ST STE 2900
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-2964
Country	:	US
Telephone Number	:	317-989-8909
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 AMERICAN SQ
Second Line	:	SUITE B1-10
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46282-0020
Country	:	US
Telephone Number	:	317-522-0844
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY M WELLS
Credential	:	M.D.
Telephone Number	:	317-989-8909

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	03/19/2021

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