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General NPI Number Information
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NPI Number | 1689630865
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Entity Type | Organization
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Legal Business Name | MEMORIAL MEDICAL CENTER
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 815 N VIRGINIA ST
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City | PORT LAVACA
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State | TX
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Zip | 77979-3025
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Country | US
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Telephone | 361-552-6713
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Fax | 361-552-0338
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Provider Business Mailing Address
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Address Line | 815 N VIRGINIA ST
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City | PORT LAVACA
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State | TX
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Zip | 77979-3025
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Country | US
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Telephone | 361-552-6713
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Fax | 361-552-0338
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Authorized Official
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Title or Position | CEO
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Name | ERIN CLEVENGER
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Credential |
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Telephone | 361-552-0240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 000487
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License Number State | TX
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