Organization
MEMORIAL MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIN CLEVENGER (CEO)
(361) 552-0454
Entity
Organization
Contact information
Practice address
815 N VIRGINIA ST, PORT LAVACA, TX 77979-3025
(361) 552-6713
(361) 552-0220
Mailing address
815 N VIRGINIA ST, PORT LAVACA, TX 77979-3025
(361) 552-6713
(361) 552-0220
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137909103
—
TX
01
—
T225
MEDICARE PART B
TX
Enumeration date
04/29/2015
Last updated
03/04/2026
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