Healthcare Provider Details

I. General information

NPI: 1730132234
Provider Name (Legal Business Name): MEMORIAL HERMANN HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 NORTH LOOP W
HOUSTON TX
77008-1532
US

IV. Provider business mailing address

PO BOX 301208
DALLAS TX
75303-1208
US

V. Phone/Fax

Practice location:
  • Phone: 713-456-5000
  • Fax: 713-338-4158
Mailing address:
  • Phone: 713-338-4127
  • Fax: 713-338-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number000407
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number000119
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number000615
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number000172
License Number StateTX

VIII. Authorized Official

Name: MR. DENNIS LARAWAY
Title or Position: CFO
Credential:
Phone: 713-242-2707