Basic Information
| Provider Information | |||||||||
| NPI: | 1811942238 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KPH-CONSOLIDATION, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HCA HOUSTON HEALTHCARE NORTH CYPRESS A CAMPUS OF HCA HOUSTON HEALTHCAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22999 HIGHWAY 59 N | ||||||||
| Address2: | |||||||||
| City: | KINGWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773394412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813488000 | ||||||||
| FaxNumber: | 2813488010 | ||||||||
| Practice Location | |||||||||
| Address1: | 22999 HIGHWAY 59 N | ||||||||
| Address2: | |||||||||
| City: | KINGWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813488000 | ||||||||
| FaxNumber: | 2813488010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | BRYAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2813488003 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 565303 | 01 | HEALTHLINK | OTHER | 373839300 | 01 | US DEPT LABOR | OTHER | 112724302 | 05 | TX | MEDICAID | 517076 | 01 | AETNA HMO | OTHER | HH0863 | 01 | TX | BCBS | OTHER |