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NPI Code Detail

MEDICARE: MEMORIAL MEDICAL CENTER

MEDICARE: MEMORIAL MEDICAL CENTER
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
1314000000XSkilled Nursing Facility

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
167-6310OTHERTXMEDICARE CCN

General Provider Information

NPI Number : 1497143259
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEMORIAL MEDICAL CENTER
Provider Business Mailing Address
First Line : 815 N VIRGINIA ST
Second Line :
City : PORT LAVACA
State : TX
Zip : 77979-3025
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2101 GREENHOUSE RD
Second Line :
City : HOUSTON
State : TX
Zip : 77084-6108
Country : US
Telephone Number : 281-599-5540
Fax Number :
Authorized Official
Title or Position : CEO
Name : JASON ANGLIN
Credential :
Telephone Number : 361-552-6713
Provider Enumeration Date : 01/02/2015
Last Update Date : 08/25/2015

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Directions to “MEMORIAL MEDICAL CENTER ” Practice Location

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