Organization
MEMORIAL MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE CHRIS MOORE (CFO)
(361) 552-0224
Entity
Organization
Contact information
Practice address
815 N VIRGINIA ST, PORT LAVACA, TX 77979-3025
(361) 552-0224
(361) 552-0220
Mailing address
815 N VIRGINIA ST, PORT LAVACA, TX 77979-3025
(361) 552-0224
(361) 552-0220
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
000487
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137909111
—
TX
Enumeration date
12/04/2014
Last updated
12/04/2014
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