Provider Demographics
NPI:1710907563
Name:BOARD OF TRUSTEES OF HOWARD COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:BOARD OF TRUSTEES OF HOWARD COMMUNITY HOSPITAL
Other - Org Name:HOWARD REGIONAL HEALTH SYSTEM
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:765-453-7189
Mailing Address - Street 1:PO BOX 1024
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1024
Mailing Address - Country:US
Mailing Address - Phone:765-236-0786
Mailing Address - Fax:765-236-0790
Practice Address - Street 1:2401 COLUMBUS BLVD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6455
Practice Address - Country:US
Practice Address - Phone:765-236-0786
Practice Address - Fax:765-236-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200484030Medicaid
IN200484030Medicaid