MEMORIAL MEDICAL CENTER (NPI# 1497153589) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497153589 |
| Entity Type | Organization |
| Organization Name | MEMORIAL MEDICAL CENTER |
| Other Organization Name | MEMORIAL MEDICAL CLINIC |
| Practice Address |
1016 N. Virginia St. Port Lavaca TX 77979-0000 |
| Mailing Address |
815 N Virginia St Port Lavaca TX 77979-3025 |
| Practice Telephone | 3615520325 |
| Practice Fax Number | 3615528759 |
| Mailing Telephone | 3615526713 |
| Mailing Fax Number | 3615520220 |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2016-02-09 |
| Authorized Official Name | JASON ANGLIN (CEO) |
| Authorized Official Telephone | 3615526713 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | TX | Allopathic & Osteopathic Physicians | |
| N | 207R00000X | Internal Medicine | TX | Allopathic & Osteopathic Physicians | |
| N | 207V00000X | Obstetrics & Gynecology | TX | Allopathic & Osteopathic Physicians | |
| N | 207X00000X | Orthopaedic Surgery | TX | Allopathic & Osteopathic Physicians | |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
TX | Physician Assistants & Advanced Practice Nursing Providers | |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
TX | Physician Assistants & Advanced Practice Nursing Providers | |
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
TX | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 137909112 | 05 | |
| TX | MEDICARE RHC | 673422 | 01 |
| Other Name | Type Code |
|---|---|
| MEMORIAL MEDICAL CLINIC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538719836 | Memorial Medical Center | Nursing Care | 118 Trinity Shores Drive, Port Lavaca, TX 77979 | 2019-09-18 |
| 1588075964 | Memorial Medical Center | Skilled Nursing Facility | 2100 Dove Crossing Ln, Navasota, TX 77868-5247 | 2014-05-19 |
| 1275717894 | Memorial Medical Center | Skilled Nursing Facility | 2750 Miller Ranch Rd, Pearland, TX 77584-9763 | 2007-12-18 |
| 1679549968 | Memorial Medical Center | Audiologist | 644 North Second Street, Springfield, IL 62781-0001 | 2006-02-27 |
| 1124099098 | Memorial Medical Center | General Acute Care Hospital | 701 N !st St, Mab 528, Springfield, IL 62781-0001 | 2006-01-30 |
| 1922092790 | Memorial Medical Center | Skilled Nursing Facility | 1008 Enterprise Blvd, Rockport, TX 78382-3201 | 2005-09-07 |
| 1568017481 | Memorial Medical Center | Clinic/Center | 701 N 1st St, Springfield, IL 62781-0001 | 2019-08-07 |
| 1053964742 | Memorial Medical Center | Orthopaedic Surgery | 815 N Virginia St, Port Lavaca, TX 77979-3025 | 2019-07-22 |
| 1164954806 | Memorial Medical Center | Internal Medicine | 701 N 1st St, Mailbox 95, Springfield, IL 62781-0001 | 2017-03-31 |
| 1104203181 | Memorial Medical Center | Surgery | 815 N Virginia St, Port Lavaca, TX 77979-3025 | 2015-04-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MEMORIAL MEDICAL CENTER | 8260 Atlee Rd Ste 1203, Mechanicsville, VA 23116-1844 |
| System for Award Management (SAM) Entities | MEMORIAL MEDICAL CENTER INC | 1615 Maple Ln, Ashland, WI 54806-3610 |
| System for Award Management (SAM) Entities | MEMORIAL MEDICAL CENTER OF EAST TEXAS | 1201 W Frank Ave, Lufkin, TX 75904-3357 |
| Street Address |
1016 N. VIRGINIA ST. |
| City | PORT LAVACA |
| State | TX |
| Zip Code | 77979-0000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538719836 | Memorial Medical Center | Nursing Care | 118 Trinity Shores Drive, Port Lavaca, TX 77979 | 2019-09-18 |
| 1972083475 | Kelly Leigh Meyer | Occupational Therapy Assistant | Port Lavaca Nursing and Rehabilitation Center, 524 Village Rd, Port Lavaca, TX 77979 | 2018-08-15 |
| 1679943393 | Vrinda Mohunta | Dentist | 204 Tx-35, Port Lavaca, TX 77979 | 2015-10-07 |
| 1770999344 | Smile Experts Pllc | Dentist | 204 State Hwy 35 South, Port Lavaca, TX 77979 | 2014-07-03 |
| 1083927636 | Calhoun Home Health, LLC | Home Health | 1300 N Virginia St Ste 111, Port Lavaca, TX 77979 | 2010-07-23 |
| 1740423490 | Diana E. Garcia | Case Manager/Care Coordinator | 3272 U.S. Hwy 87, Port Lavaca, TX 77979 | 2009-04-10 |
| 1982844940 | Gillian V. Kwi | Dentist | 1112 Half League Rd, Port Lavaca, TX 77979 | 2009-03-03 |
| 1003054057 | Ngale Ndiva Mongoh | Pharmacist | 325 S. Hwy. 35 By Pass, Port Lavaca, TX 77979 | 2009-01-29 |
| 1326248592 | Nichole Lynn Bruno | Nurse Practitioner | 1300 N. Virginia Street, Port Lavaca, TX 77979 | 2007-07-24 |
| 1518168855 | Calhoun County Senior Citizens Assoc. Inc. | Home Delivered Meals | 2104 W Austin St., Port Lavaca, TX 77979 | 2007-05-31 |
| Find all providers in zip 77979 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639776586 | West Texas Family Medicine, Pllc | Clinic/Center | 315 W Cleveland St, Hale Center, TX 79041 | 2020-10-05 |
| 1780298547 | Coryell County Memorial Hospital Authority | Clinic/Center | 498 Avenue E, Moody, TX 76557-3579 | 2020-08-31 |
| 1760005953 | Eastland Memorial Hospital District | Clinic/Center | Walnut Street Clinic, 200 Walnut Street Clinic, Ranger, TX 76448-7644 | 2020-05-21 |
| 1023631306 | Eastland Memorial Hospital District | Clinic/Center | Emh Regional Healthcare Clinic, 2314 W. Commerce Street, Eastland, TX 76448-7644 | 2020-05-21 |
| 1346862752 | Ascension Seton | Clinic/Center | 249 Sportsplex Dr., Suite 204, Dripping Springs, TX 78620-2350 | 2020-05-08 |
| 1255977211 | Frio Hospital Association | Clinic/Center | 801 Fm W 117, Dilley, TX 78017 | 2019-11-25 |
| 1700447950 | Scott & White Hospital - Marble Falls | Clinic/Center | 105 Fm2342, Kingsland, TX 78639-6010 | 2019-06-27 |
| 1275193005 | Brenham Family Practice and Obstetrics Pa | Clinic/Center | 601 Medical Pkwy Ste D, Brenham, TX 77833-5430 | 2019-06-14 |
| 1588137103 | Nocona Hospital District | Clinic/Center | 108 E Boggess St, Saint Jo, TX 76265-0238 | 2019-01-07 |
| 1033687900 | Gainesville Community Hospital, Inc. | Clinic/Center | 801 N Grand Ave Ste 1&4, Gainesville, TX 76240-3573 | 2018-11-08 |
| Find all providers with the same taxonomy | ||||
| City | PORT LAVACA |
| Zip Code | 77979 |
Please comment or provide details below to improve the information on MEMORIAL MEDICAL CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.