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
1	CJ7720	OTHER	IN	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1952400509	OTHER	IN	GROUP NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952400509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS PRACTICE ORGANIZATION

Provider Business Mailing Address
First Line	:	2326 18TH ST
Second Line	:	SUITE 220
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5359
Country	:	US
Telephone Number	:	812-378-7474
Fax Number	:	812-378-7462

Provider Business Practice Location Address
First Line	:	2326 18TH ST
Second Line	:	SUITE 220
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5359
Country	:	US
Telephone Number	:	812-378-7474
Fax Number	:	812-378-7462

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DAVID RAU
Credential	:	MD
Telephone Number	:	812-378-7474

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	06/22/2010

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Directions to “PHYSICIANS PRACTICE ORGANIZATION ” Practice Location

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