MEDICARE: PHYSICIAN PRACTICE ORGANIZATION,

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	207V00000X	Obstetrics & Gynecology Physician	01044962	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356369219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN PRACTICE ORGANIZATION,

Provider Business Mailing Address
First Line	:	2450 N PARK DR
Second Line	:	STE A
City	:	COLUMBUS
State	:	IN
Zip	:	47203-2216
Country	:	US
Telephone Number	:	812-348-6373
Fax Number	:	812-376-4125

Provider Business Practice Location Address
First Line	:	2450 N PARK DR
Second Line	:	STE A
City	:	COLUMBUS
State	:	IN
Zip	:	47203-2216
Country	:	US
Telephone Number	:	812-348-6373
Fax Number	:	812-376-4125

Authorized Official
Title or Position	:	DOCTOR
Name	:	MR. GEORGE FRANCIS ALBERS
Credential	:	M.D.
Telephone Number	:	812-348-6373

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	10/23/2015

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