Provider Demographics
NPI:1356369219
Name:PHYSICIAN PRACTICE ORGANIZATION,
Entity type:Organization
Organization Name:PHYSICIAN PRACTICE ORGANIZATION,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:ALBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-348-6373
Mailing Address - Street 1:2450 N PARK DR
Mailing Address - Street 2:STE A
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2216
Mailing Address - Country:US
Mailing Address - Phone:812-348-6373
Mailing Address - Fax:812-376-4125
Practice Address - Street 1:2450 N PARK DR
Practice Address - Street 2:STE A
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2216
Practice Address - Country:US
Practice Address - Phone:812-348-6373
Practice Address - Fax:812-376-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044962207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200080290AMedicaid
IN200080290AMedicaid