Provider Demographics
NPI:1548387418
Name:THE METHODIST HOSPITAL
Entity Type:Organization
Organization Name:THE METHODIST HOSPITAL
Other - Org Name:HOUSTON METHODIST HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-441-2671
Mailing Address - Street 1:PO BOX 4755
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4755
Mailing Address - Country:US
Mailing Address - Phone:832-522-7574
Mailing Address - Fax:
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-790-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0124261QA1903X
TX00124261QE0700X, 273Y00000X, 282N00000X, 314000000X
TX000124273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No273R00000XHospital UnitsPsychiatric Unit
No273Y00000XHospital UnitsRehabilitation Unit
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0001OtherCHAMPUS REHAB
TX0000OtherCHAMPUS ACUTE PSYCH CHEM
TX137949703Medicaid
TX0000OtherCHAMPUS ACUTE PSYCH CHEM
TX137949713Medicaid
TX0001OtherCHAMPUS REHAB
TX452324Medicare Oscar/Certification
TX0001OtherCHAMPUS REHAB
TX137949705Medicaid
TX45S358Medicare Oscar/Certification
TX137949704Medicaid