Organization
MEMORIAL MEDICAL CENTER-SAN AUGUSTINE
Active
Parent organization
MEMORIAL MEDICAL CENTER-SAN AUGUSTINE
Other names
San Augustine Dialysis Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEMORIAL MEDICAL CENTER-SAN AUGUSTINE
Authorized official
MR. RICHARD AHRENS (CFO)
(936) 634-8111
Entity
Organization
Contact information
Practice address
403 NORTH MILAM STREET, SAN AUGUSTINE, TX 75972-2121
(936) 275-3446
(936) 275-9921
Mailing address
PO BOX 1447, LUFKIN, TX 75902-1447
(936) 275-3446
(936) 275-9921
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130734007
—
TX
Enumeration date
07/16/2008
Last updated
05/06/2009
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