Basic Information
| Provider Information | |||||||||
| NPI: | 1508156811 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS' PRACTICE ORGANIZATION, INC | ||||||||
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| OtherOrganizationName: | SOUTHEASTERN INDIANA CANCER CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 PLAZA DR | ||||||||
| Address2: | SUITE H | ||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472012916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123733024 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 17TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472015351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123733024 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2011 | ||||||||
| LastUpdateDate: | 04/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | ALESSI | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | RALPH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8123733024 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 01068313A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.