MEDICARE: PHYSICIANS PRACTICE ORGANIZATION, INC

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician		IN

General Provider Information

NPI Number	:	1255594982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS PRACTICE ORGANIZATION, INC

Provider Business Mailing Address
First Line	:	2326 18TH ST
Second Line	:	SUITE 130
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5362
Country	:	US
Telephone Number	:	812-376-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	2326 18TH ST
Second Line	:	SUITE 130
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5362
Country	:	US
Telephone Number	:	812-376-0555
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ELIZABETH ASHWORTH
Credential	:	M.D.
Telephone Number	:	812-376-0555

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	10/01/2008

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