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	3416A0800X	Air Ambulance
2	3416L0300X	Land Ambulance
3	291U00000X	Clinical Medical Laboratory		TX
4	261QA1903X	Ambulatory Surgical Clinic/Center		TX
5	282N00000X	General Acute Care Hospital	000347	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	HH0196	OTHER	BCBS

General Provider Information

NPI Number	:	1982666111
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	:

Provider Business Practice Location Address
First Line	:	6411 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-704-6614
Fax Number	:	713-704-4798

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	02/25/2016

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1114860129 — BIANCA ISABEL GARCIA DO
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Directions to “MEMORIAL HERMANN HEALTH SYSTEM ” Practice Location

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