Provider Demographics
NPI:1437253994
Name:PHYSICIANS PRACTICE ORGANIZATION
Entity Type:Organization
Organization Name:PHYSICIANS PRACTICE ORGANIZATION
Other - Org Name:KOOPMAN FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALESSI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:812-988-2223
Mailing Address - Street 1:3581 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2036
Mailing Address - Country:US
Mailing Address - Phone:812-372-0137
Mailing Address - Fax:812-372-1304
Practice Address - Street 1:3581 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2036
Practice Address - Country:US
Practice Address - Phone:812-372-0137
Practice Address - Fax:812-372-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100176320AMedicaid
INE14142Medicare UPIN
IN258220Medicare PIN