Healthcare Provider Details

I. General information

NPI: 1912035452
Provider Name (Legal Business Name): TOMBALL HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6875 FM 1488 RD SUITE 800
MAGNOLIA TX
77354-4520
US

IV. Provider business mailing address

PO BOX 889
TOMBALL TX
77377-0889
US

V. Phone/Fax

Practice location:
  • Phone: 281-252-4900
  • Fax: 281-351-7830
Mailing address:
  • Phone: 281-401-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number76
License Number StateTX

VIII. Authorized Official

Name: MR. KEITH D BARBER
Title or Position: EXEC VP COO CFO
Credential:
Phone: 281-401-7500