MEDICARE: OURHEALTH, 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	:	1881019610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OURHEALTH, LLC

Provider Business Mailing Address
First Line	:	4151 E 96TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1442
Country	:	US
Telephone Number	:	866-434-3255
Fax Number	:	866-422-0915

Provider Business Practice Location Address
First Line	:	1 AMERICAN SQ STE 2610
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46282-0004
Country	:	US
Telephone Number	:	866-434-3255
Fax Number	:	866-422-0915

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFERY M WELLS MD
Credential	:
Telephone Number	:	317-522-0823

Provider Enumeration Date	:	03/04/2014
Last Update Date	:	10/15/2018

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Directions to “OURHEALTH, LLC ” Practice Location

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