Healthcare Provider Details

I. General information

NPI: 1417246059
Provider Name (Legal Business Name): TOMBALL HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 HOLDERRIETH BLVD
TOMBALL TX
77375-6445
US

IV. Provider business mailing address

605 HOLDERRIETH BLVD
TOMBALL TX
77375-6445
US

V. Phone/Fax

Practice location:
  • Phone: 713-401-7500
  • Fax:
Mailing address:
  • Phone: 281-401-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number76
License Number StateTX

VIII. Authorized Official

Name: MR. KEITH D BARBER
Title or Position: EXECUTIVE VICE PRESIDENT COO CFO
Credential:
Phone: 281-401-7633