MEDICARE: PHYSICIAN PRACTICE ORGANIZATION DBA COLUMBUS MEDICAL

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	01032770

General Provider Information

NPI Number	:	1982610119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN PRACTICE ORGANIZATION DBA COLUMBUS MEDICAL

Provider Business Mailing Address
First Line	:	2345 N PARK DR
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4473
Country	:	US
Telephone Number	:	812-372-8293
Fax Number	:	812-378-6115

Provider Business Practice Location Address
First Line	:	2345 N PARK DR
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4473
Country	:	US
Telephone Number	:	812-372-8293
Fax Number	:	812-378-6115

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. WILMA L. OVERFELT
Credential	:
Telephone Number	:	812-372-8293

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/22/2020

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