# FAYETTE CO PHYSICIAN ORGANIZATION DBA FAMILY PRACTICE WVMC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972682748
- **Authorized official:** SURESH PATEL MD (MANAGING MEMBER)
- **Authorized official phone:** (765) 827-1903

## Contact information

- **Practice address:** 1473 E STATE ROAD 44, SUITE 2, CONNERSVILLE, IN 47331-8292
- **Practice address phone:** (765) 825-8686
- **Practice address fax:** (765) 827-1918
- **Mailing address:** PO BOX 779, CONNERSVILLE, IN 47331-0779
- **Mailing address phone:** (765) 825-8686
- **Mailing address fax:** (765) 827-1918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/03/2006
- **Last updated:** 03/25/2008