Healthcare Provider Details

I. General information

NPI: 1003899055
Provider Name (Legal Business Name): MEMORIAL ENDOSCOPY CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 CAMPBELL RD
HOUSTON TX
77055-6453
US

IV. Provider business mailing address

1233 CAMPBELL RD
HOUSTON TX
77055-6453
US

V. Phone/Fax

Practice location:
  • Phone: 713-468-9200
  • Fax: 713-465-4029
Mailing address:
  • Phone: 713-468-9200
  • Fax: 713-465-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number007907
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number007907
License Number StateTX

VIII. Authorized Official

Name: MS. DORIS L JOHNSON
Title or Position: BUSINESS DIRECTOR
Credential:
Phone: 713-468-9200