Basic Information
| Provider Information | |||||||||
| NPI: | 1952844292 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OURHEALTH PHYSICIANS GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 W MARKET ST STE 2900 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462042964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664343255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 220 VIRGINIA AVE | ||||||||
| Address2: | SUITE 1-1200 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462043709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175592055 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2016 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | LAYMAN | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CORPORATE MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3177278698 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.