Provider Demographics
NPI:1699926436
Name:HOWARD REGIONAL HEALTH SYSTEM - DAR WOUND CARE
Entity type:Organization
Organization Name:HOWARD REGIONAL HEALTH SYSTEM - DAR WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VP FINANCE
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 1311
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1311
Mailing Address - Country:US
Mailing Address - Phone:765-453-0802
Mailing Address - Fax:765-455-4258
Practice Address - Street 1:408 E SOUTHWAY BLVD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3814
Practice Address - Country:US
Practice Address - Phone:765-457-2909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center