MEDICARE: TOMBALL EXPRESS MEDICAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0002X	Emergency Care Clinic/Center

General Provider Information

NPI Number	:	1588926380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOMBALL EXPRESS MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	10077 GROGANS MILL RD
Second Line	:	PARKWOOD ONE SUITE 100
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-1000
Country	:	US
Telephone Number	:	281-292-2450
Fax Number	:

Provider Business Practice Location Address
First Line	:	24727 TOMBALL PKWY
Second Line	:	SUITE 100
City	:	TOMBALL
State	:	TX
Zip	:	77375-7877
Country	:	US
Telephone Number	:	281-516-0911
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	DR. DAVID KIRBY JR.
Credential	:	MD
Telephone Number	:	281-292-2450

Provider Enumeration Date	:	06/08/2012
Last Update Date	:	06/08/2012

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