MEDICARE: MEMORIAL WOUND CARE AND INFUSION CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
2	261QI0500X	Infusion Therapy Clinic/Center
3	261QM1300X	Multi-Specialty Clinic/Center
4	261QP2000X	Physical Therapy Clinic/Center
5	261QX0100X	Occupational Medicine Clinic/Center
6	291U00000X	Clinical Medical Laboratory
7	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
8	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1780204818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL WOUND CARE AND INFUSION CENTER

Provider Business Mailing Address
First Line	:	439 MASON PARK BLVD STE A
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-6242
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	439 MASON PARK BLVD STE A
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-6242
Country	:	US
Telephone Number	:	281-206-7806
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELIJAH COLLINS
Credential	:
Telephone Number	:	281-206-7806

Provider Enumeration Date	:	04/18/2020
Last Update Date	:	04/18/2020

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