# MEMORIAL MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Broadmoor at Creekside Park
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669860433
- **Authorized official:** JASON ANGLIN (CEO)
- **Authorized official phone:** (361) 552-6713

## Contact information

- **Practice address:** 5665 CREEKSIDE FOREST DR, THE WOODLANDS, TX 77389-4969
- **Practice address phone:** (281) 255-8180
- **Mailing address:** 815 N VIRGINIA ST, PORT LAVACA, TX 77979-3025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 01/02/2015
- **Last updated:** 08/26/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 67-6357 | MEDICARE CCN | TX |