Provider Demographics
NPI:1588848246
Name:HOWARD COMMUNITY HOSPITAL BOARD OF
Entity Type:Organization
Organization Name:HOWARD COMMUNITY HOSPITAL BOARD OF
Other - Org Name:COMMUNITY OB/GYN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
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:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-0096
Mailing Address - Country:US
Mailing Address - Phone:765-453-8040
Mailing Address - Fax:765-864-6786
Practice Address - Street 1:3510 S LAFOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3803
Practice Address - Country:US
Practice Address - Phone:765-864-8765
Practice Address - Fax:765-864-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031991207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200011260OMedicaid
IN255550Medicare PIN