Basic Information
| Provider Information | |||||||||
| NPI: | 1346827797 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OURHEALTH PHYSICIAN GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 WINOOSKI FALLS WAY | ||||||||
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| City: | WINOOSKI | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054042228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028574000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 RIVER ST | ||||||||
| Address2: | |||||||||
| City: | WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286977630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028570400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2021 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | LAYMAN | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CMO | ||||||||
| AuthorizedOfficialTelephone: | 8028570400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OURHEALTH PHYSICIANS GROUP, LLC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.