TOMBALL HOSPITAL AUTHORITY

Provider Demographics

• NPI: 1558321836
• Name: TOMBALL HOSPITAL AUTHORITY
• Entity Type: Organization
• Organization Name: TOMBALL HOSPITAL AUTHORITY
• Other - Org Name: TOMBALL REGIONAL HOSPITAL
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: COO CFO EXECUTIVE VICE PRESIDENT
• Authorized Official - Prefix: MR
• Authorized Official - First Name: KEITH
• Authorized Official - Middle Name: D
• Authorized Official - Last Name: BARBER
• Authorized Official - Phone: 281-401-7633
• Mailing Address - Street 1: PO BOX 889
• Mailing Address - City: TOMBALL
• Mailing Address - State: TX
• Mailing Address - Zip Code: 77377-0889
• Mailing Address - Country: US
• Mailing Address - Phone: 281-401-7500
• Mailing Address - Fax: 281-357-2273
• Practice Address - Street 1: 605 HOLDERRIETH BLVD
• Practice Address - City: TOMBALL
• Practice Address - State: TX
• Practice Address - Zip Code: 77375-6445
• Practice Address - Country: US
• Practice Address - Phone: 281-401-7500
• Practice Address - Fax: 281-357-2273
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: TOMBALL HOSPITAL AUTHORITY
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-03-23
• Last Update Date: 2011-03-22

Provider Licenses

State	License ID	Taxonomies
TX	76	273R00000X
TX	00076	282N00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital
No	273R00000X	Hospital Units	Psychiatric Unit

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NY	0150576	Medicaid
MS	06521548	Medicaid
VA	1558321836	Medicaid
LA	1747289	Medicaid
IA	1558321836	Medicaid
OR	278266	Medicaid
ID	5084010 00	Medicaid
GA	000107764A	Medicaid
MO	018709808	Medicaid
OK	100701890A	Medicaid
SC	11462B	Medicaid
IN	200495280A	Medicaid
KY	50000105	Medicaid
AL	HOS0670N	Medicaid
NM	000A848	Medicaid
FL	900906000	Medicaid
OH	0164914	Medicaid
AZ	025785	Medicaid
TX	131044305	Medicaid
TN	1510994	Medicaid
WI	82563400	Medicaid
CA	XHSP32324	Medicaid
ME	431420000	Medicaid
CO	95012555	Medicaid
AR	154683105	Medicaid
MA	110027294B	Medicaid
AL	1558321836	Medicaid
NJ	6999905	Medicaid
CA	XHSP42324	Medicaid
KY	50000105	Medicaid
ID	5084010 00	Medicaid
IL	=========001	Medicaid