Provider Demographics
NPI:1447582457
Name:HOWARD REGIONAL PLASTIC SURGERY
Entity Type:Organization
Organization Name:HOWARD REGIONAL PLASTIC SURGERY
Other - Org Name:HOWARD REGIONAL HEALTH SYSTEM
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO/VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-453-8179
Mailing Address - Street 1:1948 W BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-6078
Mailing Address - Country:US
Mailing Address - Phone:765-236-1290
Mailing Address - Fax:765-236-0420
Practice Address - Street 1:1948 W BOULEVARD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6078
Practice Address - Country:US
Practice Address - Phone:765-236-1290
Practice Address - Fax:765-236-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010452322086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty