Basic Information
| Provider Information | |||||||||
| NPI: | 1730126822 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KPH-CONSOLIDATION, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HCA HOUSTON HEALTHCARE KINGWOOD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22999 HIGHWAY 59 N | ||||||||
| Address2: | |||||||||
| City: | HUMBLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773394438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813488000 | ||||||||
| FaxNumber: | 2813488010 | ||||||||
| Practice Location | |||||||||
| Address1: | 22999 HIGHWAY 59 N | ||||||||
| Address2: | |||||||||
| City: | HUMBLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813488000 | ||||||||
| FaxNumber: | 2813488010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 01/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | WINSLOW | ||||||||
| AuthorizedOfficialFirstName: | VIRGIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2813488013 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KPH-CONSOLIDATION, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 135231204 | 05 | TX | MEDICAID |