Provider Demographics
NPI:1164744926
Name:B E HOWERTER, JR., M.D., P.A.
Entity Type:Organization
Organization Name:B E HOWERTER, JR., M.D., P.A.
Other - Org Name:BERNARD HOWERTER, JR., M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING/BILLER/CODER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUGATE
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:620-251-4790
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:209 W 7TH STREET, SUITE 5
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-0659
Mailing Address - Country:US
Mailing Address - Phone:620-251-4790
Mailing Address - Fax:620-251-4791
Practice Address - Street 1:209 W. 7TH STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-4903
Practice Address - Country:US
Practice Address - Phone:620-251-4790
Practice Address - Fax:620-251-4791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0415260174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0415260OtherLICENSE
KS100081680AMedicaid
KS0415260OtherLICENSE
KS100081680AMedicaid