Healthcare Provider Details

I. General information

NPI: 1053659664
Provider Name (Legal Business Name): PHYSICIANS PRACTICE ORGANIZATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 25TH ST
COLUMBUS IN
47201-3728
US

IV. Provider business mailing address

2502 25TH ST
COLUMBUS IN
47201-3728
US

V. Phone/Fax

Practice location:
  • Phone: 812-372-8883
  • Fax: 812-372-8964
Mailing address:
  • Phone: 812-372-8883
  • Fax: 812-372-8964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN ALESSI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 812-988-2223