Basic Information
| Provider Information | |||||||||
| NPI: | 1528135647 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS PRACTICE ORGANIZATION INC. 'DBA' OBSTETRICS & ASSOCIATES | ||||||||
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| OtherOrganizationName: | OB GYN ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3183 N NATIONAL RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472013164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123721581 | ||||||||
| FaxNumber: | 8123764028 | ||||||||
| Practice Location | |||||||||
| Address1: | 3183 N NATIONAL RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472013164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123721581 | ||||||||
| FaxNumber: | 8123764028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 02/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | LUCERO | ||||||||
| AuthorizedOfficialFirstName: | APRIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8123721581 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
ID Information
| ID | Type | State | Issuer | Description | 1528135647 | 01 | IN | ANTHEM MEDICAID | OTHER | 200305510 | 05 | IN | MEDICAID |