Healthcare Provider Details

I. General information

NPI: 1255527982
Provider Name (Legal Business Name): BOARD OF TRUSTEES OF HOWARD COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692 W LOGANSPORT RD
PERU IN
46970-3149
US

IV. Provider business mailing address

PO BOX 627341
INDIANAPOLIS IN
46262-0001
US

V. Phone/Fax

Practice location:
  • Phone: 765-472-3000
  • Fax: 765-472-3990
Mailing address:
  • Phone: 765-472-3000
  • Fax: 765-472-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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