Provider Demographics
NPI:1700219037
Name:CHCA CONROE LP
Entity Type:Organization
Organization Name:CHCA CONROE LP
Other - Org Name:CONROE REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-539-7413
Mailing Address - Street 1:506 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2826
Mailing Address - Country:US
Mailing Address - Phone:936-539-1111
Mailing Address - Fax:936-539-5620
Practice Address - Street 1:506 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2826
Practice Address - Country:US
Practice Address - Phone:936-539-1111
Practice Address - Fax:936-539-5620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHCA CONROE LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-09
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
45T222Medicare Oscar/Certification