Basic Information
| Provider Information | |||||||||
| NPI: | 1588926380 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOMBALL EXPRESS MEDICAL CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10077 GROGANS MILL RD | ||||||||
| Address2: | PARKWOOD ONE SUITE 100 | ||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773801000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812922450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24727 TOMBALL PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TOMBALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773757877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815160911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2012 | ||||||||
| LastUpdateDate: | 06/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | KIRBY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2812922450 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.