Provider Demographics
NPI:1255527982
Name:BOARD OF TRUSTEES OF HOWARD COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:BOARD OF TRUSTEES OF HOWARD COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
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 627341
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46262-0001
Mailing Address - Country:US
Mailing Address - Phone:765-472-3000
Mailing Address - Fax:765-472-3990
Practice Address - Street 1:1692 W LOGANSPORT RD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-3149
Practice Address - Country:US
Practice Address - Phone:765-472-3000
Practice Address - Fax:765-472-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200011260IMedicaid
IN253450Medicare PIN