Provider Demographics
NPI:1710099106
Name:PHYSICIANS PRACTICE ORGANIZATION, INC
Entity Type:Organization
Organization Name:PHYSICIANS PRACTICE ORGANIZATION, INC
Other - Org Name:NASHVILLE 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:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47448-0127
Mailing Address - Country:US
Mailing Address - Phone:812-988-2223
Mailing Address - Fax:812-988-3933
Practice Address - Street 1:103 WILLOW ST STE B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-7605
Practice Address - Country:US
Practice Address - Phone:812-988-2223
Practice Address - Fax:812-988-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
IN261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC3757OtherRR MEDICARE
IN100066570AMedicaid
IN200139770AMedicaid
153832Medicare Oscar/Certification
IN090570Medicare ID - Type Unspecified