Provider Demographics
NPI:1164538740
Name:THE BOARD OF TRUSTEES OF HOWARD COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:THE BOARD OF TRUSTEES OF HOWARD COMMUNITY HOSPITAL
Other - Org Name:HOWARD REGIONAL HEALTH SYSTEM - BERNARD FOGELSON, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-453-8179
Mailing Address - Street 1:PO BOX 7101
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46207-7101
Mailing Address - Country:US
Mailing Address - Phone:765-864-5786
Mailing Address - Fax:765-864-5787
Practice Address - Street 1:3611 S REED RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3828
Practice Address - Country:US
Practice Address - Phone:765-864-5786
Practice Address - Fax:765-864-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033570A207RC0001X
IN01058072A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200011260EMedicaid
IN200011260EMedicaid