Provider Demographics
NPI:1740469824
Name:NORTHEAST HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:NORTHEAST HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, NE HOSPITAL AUTHORITY
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HEARNSBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-540-7852
Mailing Address - Street 1:18951 N MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4217
Mailing Address - Country:US
Mailing Address - Phone:281-540-7962
Mailing Address - Fax:281-540-6375
Practice Address - Street 1:18951 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4217
Practice Address - Country:US
Practice Address - Phone:281-540-7852
Practice Address - Fax:281-540-7368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451562Medicare Oscar/Certification