Healthcare Provider Details

I. General information

NPI: 1063448124
Provider Name (Legal Business Name): MEMORIAL HERMANN HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6411 FANNIN ST
HOUSTON TX
77030-1501
US

IV. Provider business mailing address

PO BOX 301208
DALLAS TX
75303-1208
US

V. Phone/Fax

Practice location:
  • Phone: 713-704-6614
  • Fax: 713-704-4798
Mailing address:
  • Phone: 713-338-4127
  • Fax: 713-338-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number00347
License Number StateTX

VIII. Authorized Official

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