MEDICARE: MEMORIAL HERMANN COMMUNITY BENEFIT CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1851800916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL HERMANN COMMUNITY BENEFIT CORPORATION

Provider Business Mailing Address
First Line	:	909 FROSTWOOD DR STE 2.205
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2301
Country	:	US
Telephone Number	:	713-338-5983
Fax Number	:	713-338-4542

Provider Business Practice Location Address
First Line	:	315 BERRY RD # 1777
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3209
Country	:	US
Telephone Number	:	713-742-8141
Fax Number	:	713-695-2629

Authorized Official
Title or Position	:	CHIEF COMMUNITY HEALTH OFFICER
Name	:	CAROL PARET
Credential	:
Telephone Number	:	713-338-5983

Provider Enumeration Date	:	09/21/2017
Last Update Date	:	05/07/2023

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