=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831158583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOMBALL HOSPITAL AUTHORITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2006
-----------------------------------------------------
Last Update Date | 06/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13530 MICHEL RD
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-401-7681
-----------------------------------------------------
Fax | 281-351-8976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 889
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77377-0889
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-401-7500
-----------------------------------------------------
Fax | 281-351-7830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO EXECUTIVE VICE PRESIDENT
-----------------------------------------------------
Name | MR. KEITH D BARBER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-401-7633
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 00076
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------