MEDICARE: PHYSICIANS 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	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CJ9211	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ9211	OTHER	IN	PALMETTO GBA

General Provider Information

NPI Number	:	1700818127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS PRACTICE ORGANIZATION

Provider Business Mailing Address
First Line	:	3581 CENTRAL AVE
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-2036
Country	:	US
Telephone Number	:	812-376-9601
Fax Number	:	812-378-8518

Provider Business Practice Location Address
First Line	:	3581 CENTRAL AVE
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-2036
Country	:	US
Telephone Number	:	812-376-9601
Fax Number	:	812-378-8518

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN ALESSI
Credential	:	DO
Telephone Number	:	812-988-2223

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/13/2008

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Directions to “PHYSICIANS PRACTICE ORGANIZATION ” Practice Location

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