1609876309 NPI number — TRIUMPH HOSPITAL OF EAST HOUSTON, LP

Table of content: (NPI 1609876309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609876309 NPI number — TRIUMPH HOSPITAL OF EAST HOUSTON, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRIUMPH HOSPITAL OF EAST HOUSTON, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KINDRED HOSPITAL CLEAR LAKE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609876309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/22/2016
NPI Reactivation Date:
12/02/2016

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 BLOSSOM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEBSTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77598-4206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-316-7800
Provider Business Mailing Address Fax Number:
281-316-7828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 BLOSSOM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77598-4206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-316-7800
Provider Business Practice Location Address Fax Number:
281-316-7828
Provider Enumeration Date:
07/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TEAGUE
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official Telephone Number:
629-253-5121

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  007204 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HH1006 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 149047601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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