# EDMONDSON ROSS & HURST MEMORIAL CLINIC PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MEMORIAL CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033376744
- **Authorized official:** DR. KEVIN BRENT STACKS MD (SOLE MEMBER)
- **Authorized official phone:** (903) 892-2781

## Contact information

- **Practice address:** 600 N HIGHLAND AVE, SUITE 105, SHERMAN, TX 75092-5631
- **Practice address phone:** (903) 892-2781
- **Practice address fax:** (903) 892-2780
- **Mailing address:** 600 N HIGHLAND AVE, SUITE 104, SHERMAN, TX 75092-5631
- **Mailing address phone:** (903) 870-4609
- **Mailing address fax:** (903) 891-2025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | K7908 | TX | Yes |

## Other

- **Enumeration date:** 05/20/2008
- **Last updated:** 03/15/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 195685601 | — | TX |