MEDICARE: MEMORIAL MULTISPECIALTY ASSOCIATES

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	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0020BV	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295789337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL MULTISPECIALTY ASSOCIATES

Provider Business Mailing Address
First Line	:	2 GREENWAY PLZ STE 900
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77046-0205
Country	:	US
Telephone Number	:	713-798-1128
Fax Number	:

Provider Business Practice Location Address
First Line	:	8558 CREEKSIDE FOREST DR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77375-2175
Country	:	US
Telephone Number	:	713-798-1128
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RICHARD C ALLISON III
Credential	:
Telephone Number	:	713-798-1746

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	07/29/2020

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