Provider Demographics
NPI:1831158583
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 1:13530 MICHEL RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3305
Practice Address - Country:US
Practice Address - Phone:281-401-7681
Practice Address - Fax:281-351-8976
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOMBALL HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-21
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00076251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154683105Medicaid
NJ6999905Medicaid
CAXHSP42324Medicaid
GA000107764AMedicaid
TX023908901Medicaid
IN200495280AMedicaid
ME431420000Medicaid
KY50000105Medicaid
NY0150576Medicaid
AZ025785Medicaid
ALHOS0670NMedicaid
CAXHSP32324Medicaid
NM000A848Medicaid
MO018709808Medicaid
MS06521548Medicaid
LA1747289Medicaid
FL900906000Medicaid
ALHOS0670NMedicaid
CAXHSP32324Medicaid
ALHOS0670NMedicaid