Basic Information
| Provider Information | |||||||||
| NPI: | 1376073114 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MH EMERUS TOMBALL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8686 NEW TRAILS DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773811176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136371146 | ||||||||
| FaxNumber: | 2812985311 | ||||||||
| Practice Location | |||||||||
| Address1: | 24429 TOMBALL PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | TOMBALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773758214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815160911 | ||||||||
| FaxNumber: | 7136371305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2017 | ||||||||
| LastUpdateDate: | 11/06/2018 | ||||||||
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| AuthorizedOfficialLastName: | BUCK | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 7136371004 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 379968601 | 05 | TX | MEDICAID | 670095 | 01 | TX | MEDICARE | OTHER |