Provider Demographics
NPI:1144651514
Name:TOMBALL EXPRESS MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:TOMBALL EXPRESS MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:EKNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-637-1144
Mailing Address - Street 1:8686 NEW TRAILS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1176
Mailing Address - Country:US
Mailing Address - Phone:713-637-1144
Mailing Address - Fax:281-292-3585
Practice Address - Street 1:24429 TOMBALL PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:281-516-0911
Practice Address - Fax:713-637-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340639901Medicaid
TX340639902Medicaid
TX670095Medicare Oscar/Certification