Organization
MEMORIAL MEDICAL CENTER
Active
Other names
MEMORIAL MEDICAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
ERIN CLEVENGER (CEO)
(361) 552-6713
Entity
Organization
Contact information
Practice address
1016 N VIRGINIA ST, PORT LAVACA, TX 77979-3000
(361) 552-0325
(361) 500-6904
Mailing address
815 N VIRGINIA ST, PORT LAVACA, TX 77979-3025
(361) 552-6713
(361) 552-0220
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
TX
207R00000X
Internal Medicine Physician
—
TX
207V00000X
Obstetrics & Gynecology Physician
—
TX
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
TX
363LF0000X
Family Nurse Practitioner
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137909112
—
TX
01
—
673422
MEDICARE RHC
TX
Enumeration date
12/05/2014
Last updated
10/30/2024
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