Provider Demographics
NPI:1801116843
Name:FAMILY PHYSICIANS OF JOHNSON COUNTY
Entity type:Organization
Organization Name:FAMILY PHYSICIANS OF JOHNSON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-736-3396
Mailing Address - Street 1:1155 W JEFFERSON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2731
Mailing Address - Country:US
Mailing Address - Phone:317-736-7738
Mailing Address - Fax:317-736-6403
Practice Address - Street 1:1155 W JEFFERSON ST STE 101
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2731
Practice Address - Country:US
Practice Address - Phone:317-736-7738
Practice Address - Fax:317-736-6403
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNSON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-01
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM100024970OtherMEDICARE PTAN