Provider Demographics
NPI:1619473360
Name:OURHEALTH PHYSICIAN GROUP, LLC
Entity Type:Organization
Organization Name:OURHEALTH PHYSICIAN GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IMPLEMENTATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-559-0970
Mailing Address - Street 1:10 W MARKET ST STE 2900
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2964
Mailing Address - Country:US
Mailing Address - Phone:866-434-3255
Mailing Address - Fax:866-422-0915
Practice Address - Street 1:12734 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4270
Practice Address - Country:US
Practice Address - Phone:866-434-3255
Practice Address - Fax:844-675-6719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OURHEALTH PHYSICIAN GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-02
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care