Provider Demographics
NPI:1750341038
Name:TOMBALL HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:TOMBALL HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position: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:281-401-7633
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:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00076314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXHSP42324Medicaid
AK154683105Medicaid
FL900906000Medicaid
MO018709808Medicaid
LA1747289Medicaid
IN200495280AMedicaid
KY50000105Medicaid
NJ6999905Medicaid
ALHOS0670NMedicaid
GA000107764AMedicaid
ME431420000Medicaid
AZ025785Medicaid
NM000A848Medicaid
TX13044305Medicaid
MS06521548Medicaid
CAXHSP32324Medicaid
MS06521548Medicaid
KY50000105Medicaid
FL900906000Medicaid
CAXHSP32324Medicaid