Provider Demographics
NPI:1295795573
Name:TOMBALL HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:TOMBALL HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position: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 - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-401-7633
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:281-351-7830
Practice Address - Street 1:605 HOLDERRIETH BLVD
Practice Address - Street 2:
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:281-351-7830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOMBALL HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-23
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00076273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX021805901Medicaid
CAXHSP32324Medicaid
NM000A848Medicaid
NJ6999905Medicaid
ALHOS0670NMedicaid
AZ025785Medicaid
OK100701890AMedicaid
ME431420000Medicaid
CAXHSP42324Medicaid
NY0150576Medicaid
MO018709808Medicaid
FL900906000Medicaid
AR154683105Medicaid
KY50000105Medicaid
MS06521548Medicaid
LA1747289Medicaid
IN200495280AMedicaid
CAXHSP32324Medicaid
CAXHSP42324Medicaid
NY0150576Medicaid