Basic Information
Provider Information | |||||||||
NPI: | 1831158583 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | TOMBALL HOSPITAL AUTHORITY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | TRH HOME HEALTH | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 889 | ||||||||
Address2: |   | ||||||||
City: | TOMBALL | ||||||||
State: | TX | ||||||||
PostalCode: | 773770889 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2814017500 | ||||||||
FaxNumber: | 2813517830 | ||||||||
Practice Location | |||||||||
Address1: | 13530 MICHEL RD | ||||||||
Address2: |   | ||||||||
City: | TOMBALL | ||||||||
State: | TX | ||||||||
PostalCode: | 773753305 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2814017681 | ||||||||
FaxNumber: | 2813518976 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/21/2006 | ||||||||
LastUpdateDate: | 06/30/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BARBER | ||||||||
AuthorizedOfficialFirstName: | KEITH | ||||||||
AuthorizedOfficialMiddleName: | D | ||||||||
AuthorizedOfficialTitleorPosition: | CFO EXECUTIVE VICE PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 2814017633 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | TOMBALL HOSPITAL AUTHORITY | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 00076 | TX | Y |   | Agencies | Home Health |   |
ID Information
ID | Type | State | Issuer | Description | 154683105 | 05 | AR |   | MEDICAID | 6999905 | 05 | NJ |   | MEDICAID | XHSP42324 | 05 | CA |   | MEDICAID | 000107764A | 05 | GA |   | MEDICAID | 023908901 | 05 | TX |   | MEDICAID | 200495280A | 05 | IN |   | MEDICAID | 431420000 | 05 | ME |   | MEDICAID | 50000105 | 05 | KY |   | MEDICAID | 0150576 | 05 | NY |   | MEDICAID | 025785 | 05 | AZ |   | MEDICAID | HOS0670N | 05 | AL |   | MEDICAID | XHSP32324 | 05 | CA |   | MEDICAID | 000A848 | 05 | NM |   | MEDICAID | 018709808 | 05 | MO |   | MEDICAID | 06521548 | 05 | MS |   | MEDICAID | 1747289 | 05 | LA |   | MEDICAID | 900906000 | 05 | FL |   | MEDICAID |