Provider Demographics
NPI:1518068527
Name:PHYSICIANS PRACTICE ORGANIZATION D/B/A NORTHSIDE FAMILY MEDICINE
Entity Type:Organization
Organization Name:PHYSICIANS PRACTICE ORGANIZATION D/B/A NORTHSIDE FAMILY MEDICINE
Other - Org Name:NORTHSIDE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOVINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-372-4956
Mailing Address - Street 1:3201 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-4427
Mailing Address - Country:US
Mailing Address - Phone:812-372-4956
Mailing Address - Fax:812-372-4958
Practice Address - Street 1:3201 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4427
Practice Address - Country:US
Practice Address - Phone:812-372-4956
Practice Address - Fax:812-372-4958
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS PRACTICE ORGANIZATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN252450Medicare PIN