Healthcare Provider Details

I. General information

NPI: 1659554830
Provider Name (Legal Business Name): MEMORIAL HERMANN HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10905 MEMORIAL HERMANN DR SUITE 104
PEARLAND TX
77584-3490
US

IV. Provider business mailing address

PO BOX 301208
DALLAS TX
75303-1208
US

V. Phone/Fax

Practice location:
  • Phone: 713-997-5236
  • Fax: 713-338-4158
Mailing address:
  • Phone: 713-338-4127
  • Fax: 713-338-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

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