Healthcare Provider Details

I. General information

NPI: 1396807335
Provider Name (Legal Business Name): BOARD OF TRUSTESS OF HOWARD COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 S REED RD
KOKOMO IN
46902-3838
US

IV. Provider business mailing address

PO BOX 3002
INDIANAPOLIS IN
46206-3002
US

V. Phone/Fax

Practice location:
  • Phone: 765-453-8666
  • Fax: 765-453-8506
Mailing address:
  • Phone: 765-453-8666
  • Fax: 765-453-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number01056223
License Number StateIN

VIII. Authorized Official

Name: THOMAS M COOK
Title or Position: CHEIF FINANCIAL OFFICER
Credential: CFO
Phone: 765-453-8179