Healthcare Provider Details

I. General information

NPI: 1801810346
Provider Name (Legal Business Name): BOARD OF TRUSTEES OF HOWARD COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 S LAFOUNTAIN ST
KOKOMO IN
46902-3803
US

IV. Provider business mailing address

3500 S LAFOUNTAIN ST
KOKOMO IN
46902-3803
US

V. Phone/Fax

Practice location:
  • Phone: 765-453-8571
  • Fax: 765-453-8637
Mailing address:
  • Phone: 765-453-8571
  • Fax: 765-453-8637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01067807A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01056265A
License Number StateIN

VIII. Authorized Official

Name: MR. THEODORE T BROWN
Title or Position: COO
Credential:
Phone: 765-453-8456