# COMMUNITY HOWARD PHYSICIAN NETWORK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013358365
- **Authorized official:** JOSEPH HOOPER (CFO)
- **Authorized official phone:** (317) 621-7561

## Contact information

- **Practice address:** 3500 S LAFOUNTAIN ST, KOKOMO, IN 46902-3803
- **Practice address phone:** (317) 621-9312
- **Mailing address:** 6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/16/2013
- **Last updated:** 12/10/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 201183180 | — | IN |
| 01 | — | DU3904 | GROUP MEDICARE RR | IN |