Provider Demographics
NPI:1912035452
Name:TOMBALL HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:TOMBALL HOSPITAL AUTHORITY
Other - Org Name:TOMBALL REGONAL HOSPITAL MINOR CARE CENTER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP COO CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-401-7500
Mailing Address - Street 1:PO BOX 889
Mailing Address - Street 2:
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:
Practice Address - Street 1:6875 FM 1488 RD
Practice Address - Street 2:SUITE 800
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4520
Practice Address - Country:US
Practice Address - Phone:281-252-4900
Practice Address - Fax:281-351-7830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOMBALL HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131044303Medicaid
TX450670Medicare Oscar/Certification