Basic Information
| Provider Information | |||||||||
| NPI: | 1710099106 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PHYSICIANS PRACTICE ORGANIZATION, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | NASHVILLE FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 127 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474480127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129882223 | ||||||||
| FaxNumber: | 8129883933 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 WILLOW ST STE B | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474487605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129882223 | ||||||||
| FaxNumber: | 8129883933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/29/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ALESSI | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8129882223 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | IN | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | CC3757 | 01 | RR MEDICARE | OTHER | 100066570A | 05 | IN | MEDICAID | 200139770A | 05 | IN | MEDICAID |