Organization
MEMORIAL MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIN CLEVENGER (CEO)
(361) 552-0240
Entity
Organization
Contact information
Practice address
815 N VIRGINIA ST, PORT LAVACA, TX 77979-3025
(361) 552-6713
(361) 552-0338
Mailing address
815 N VIRGINIA ST, PORT LAVACA, TX 77979-3025
(361) 552-6713
(361) 552-0338
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
000487
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022476801
—
TX
05
—
137909101
—
TX
05
—
137909103
—
TX
05
—
137909104
—
TX
05
—
137909107
—
TX
05
—
137909111
—
TX
05
—
142448301
—
TX
01
—
HH0489
BLUE CROSS
TX
Enumeration date
04/25/2006
Last updated
03/02/2026
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