=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437218062
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONTGOMERY COUNTY HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 06/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 SOUTH LOOP 336 WEST
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77304-3504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-523-1128
-----------------------------------------------------
Fax | 936-539-2766
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2587
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77305-2587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-523-1128
-----------------------------------------------------
Fax | 936-539-2766
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MRS. KAREN RITA WEBB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 936-523-1128
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 300189
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------