MEDICARE: MEMORIAL HERMANN HEALTH SYSTEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104012699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL HERMANN HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	PO BOX 301208
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75303-1208
Country	:	US
Telephone Number	:	713-338-4127
Fax Number	:	713-338-4158

Provider Business Practice Location Address
First Line	:	7789 SOUTHWEST FWY
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77074-1829
Country	:	US
Telephone Number	:	713-338-4127
Fax Number	:	713-338-4158

Authorized Official
Title or Position	:	CFO
Name	:	MR. DENNIS LARAWAY
Credential	:
Telephone Number	:	713-242-2707

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	06/27/2014

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Directions to “MEMORIAL HERMANN HEALTH SYSTEM ” Practice Location

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