Healthcare Provider Details

I. General information

NPI: 1639263569
Provider Name (Legal Business Name): PHYSICIAN'S PRACTICE ORGANIZATION, INC. D/B/A COLUMBUS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N MARR RD
COLUMBUS IN
47201-5505
US

IV. Provider business mailing address

1120 N MARR RD
COLUMBUS IN
47201-5505
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-9219
  • Fax: 812-348-0297
Mailing address:
  • Phone: 812-376-9219
  • Fax: 812-348-0297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBBIE HYER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 812-376-9219