Provider Demographics
NPI:1528135647
Name:PHYSICIANS PRACTICE ORGANIZATION INC. 'DBA' OBSTETRICS & ASSOCIATES
Entity type:Organization
Organization Name:PHYSICIANS PRACTICE ORGANIZATION INC. 'DBA' OBSTETRICS & ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-372-1581
Mailing Address - Street 1:3183 N NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-3164
Mailing Address - Country:US
Mailing Address - Phone:812-372-1581
Mailing Address - Fax:812-376-4028
Practice Address - Street 1:3183 N NATIONAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3164
Practice Address - Country:US
Practice Address - Phone:812-372-1581
Practice Address - Fax:812-376-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1528135647OtherANTHEM MEDICAID
IN200305510Medicaid
IN200305510Medicaid