NPIMap

Organization Active NPI

Edmondson Ross & Hurst Memorial Clinic PLLC

Doing business as Memorial Clinic

  • General Practice Physician
  • Sherman, TX
National Provider Identifier
1033376744
Registry record updated Mar 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
K7908 Issued in TX
Legal business name
EDMONDSON ROSS & HURST MEMORIAL CLINIC PLLC
Doing business as
Memorial Clinic
Practice address
600 N Highland Ave
Suite 105
Sherman, TX 75092-5631
Phone
(903) 892-2781
Fax
(903) 892-2780
NPI assigned
May 20, 2008
Last updated
Mar 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kevin Brent Stacks, MDNPI 1679596423
Title
Sole Member
Phone
(903) 892-2781

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X K7908 TX Primary

Addresses

Primary practice location

600 N Highland Ave
Suite 105
Sherman, TX 75092-5631

Mailing address

600 N Highland Ave
Suite 104
Sherman, TX 75092-5631
Phone (903) 870-4609

Other identifiers 1

IdentifierTypeStateIssuer
195685601MedicaidTX

Other names 1

  • MEMORIAL CLINIC Doing business as

National Provider Directory

National Provider Directory

Locations

600 N Highland Ave
Ste 104
Sherman, TX 75092
Phone (903) 821-9688

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268611200000",
    "number": "1033376744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N HIGHLAND AVE",
            "address_2": "SUITE 104",
            "city": "SHERMAN",
            "state": "TX",
            "postal_code": "750925631",
            "telephone_number": "903-870-4609",
            "fax_number": "903-891-2025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N HIGHLAND AVE",
            "address_2": "SUITE 105",
            "city": "SHERMAN",
            "state": "TX",
            "postal_code": "750925631",
            "telephone_number": "903-892-2781",
            "fax_number": "903-892-2780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDMONDSON ROSS & HURST MEMORIAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2010-03-15",
        "status": "A",
        "authorized_official_last_name": "STACKS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "BRENT",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "903-892-2781",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "K7908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195685601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEMORIAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sherman, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.