Organization
COMMUNITY HOWARD PHYSICIAN NETWORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH HOOPER (CFO)
(317) 621-7561
Entity
Organization
Contact information
Practice address
3500 S LAFOUNTAIN ST, KOKOMO, IN 46902-3803
(317) 621-9312
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201183180
—
IN
01
—
DU3904
GROUP MEDICARE RR
IN
Enumeration date
07/16/2013
Last updated
12/10/2014
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