Provider Demographics
NPI:1437218062
Name:MONTGOMERY COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY HOSPITAL DISTRICT
Other - Org Name:MCHD-EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-523-1128
Mailing Address - Street 1:PO BOX 2587
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305-2587
Mailing Address - Country:US
Mailing Address - Phone:936-523-1128
Mailing Address - Fax:936-539-2766
Practice Address - Street 1:1400 SOUTH LOOP 336 WEST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3504
Practice Address - Country:US
Practice Address - Phone:936-523-1128
Practice Address - Fax:936-539-2766
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-08
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300189341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX47240OtherHMO BLUE STAR PLUS 81053
CAXMTE06119OtherCAID SAN MATEO CA
TX0070831OtherBC BS OF TN 180150
PA296743OtherBC BS OF PA 898845
TX300189OtherESIS 419310
TX41527OtherCHIPS AMERIKIDS 62947
TX107752101Medicaid
TX590006512OtherRR MCARE 10066
TXAMB300189OtherTEXAS MUTUAL 841843
TX300128OtherTEXAS MUTUAL 12029
TX1014892OtherAETNA 1125
TX41527OtherCHIPS AMERIKIDS 62947