Healthcare Provider Details

I. General information

NPI: 1275568032
Provider Name (Legal Business Name): MEMORIAL HERMANN HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 GESSNER SUITE 200
HOUSTON TX
77024-2314
US

IV. Provider business mailing address

PO BOX 301208
DALLAS TX
75303-1208
US

V. Phone/Fax

Practice location:
  • Phone: 713-242-3700
  • 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 Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS LARAWAY
Title or Position: VP-GOVERNMENT REPORTING & MGD CARE
Credential:
Phone: 713-242-2785