NPIMap

Organization Active NPI

Memorial Medical Center

Doing business as Memorial Medical Clinic Hospital Campus

  • Rural Health Clinic/Center
  • Port Lavaca, TX
National Provider Identifier
1053964742
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MEMORIAL MEDICAL CENTER
Doing business as
Memorial Medical Clinic Hospital Campus
Practice address
815 N Virginia St FL 2
Port Lavaca, TX 77979-3025
Phone
(361) 552-0379
Fax
(361) 500-6904
NPI assigned
Jul 22, 2019
Last updated
Sep 19, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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

Authorized official

Name
Erin Clevenger
Title
Ceo
Phone
(361) 552-6713

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Obstetrics & Gynecology Physician 207V00000X NU
General Practice Physician 208D00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

815 N Virginia St FL 2
Port Lavaca, TX 77979-3025

Mailing address

815 N Virginia St
Port Lavaca, TX 77979-3025
Phone (361) 552-0325

Other names 1

  • Memorial Medical Clinic Hospital Campus Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmrhc@mmcportlavaca.hin.us

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191206000453 TX Part A Provider - Rural Health Clinic 3072403096 Practice locations: Port Lavaca, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053964742. Details of each certification follow.

Rural health clinic certification: CCN 673479

Legal name
MEMORIAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 30, 2020
Last certification
Jan 5, 2026
Ownership / control type
2B
Organization structure
GovernmentNon-profit
Incorporated
Jul 14, 1947 in TX
Enrollment address
815 N Virginia St
Suite 101 Suite 201
Port Lavaca, TX 77979-3025
Related CCNs
451356

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Memorial Med Ctr Amb7 organizations share this tax ID, including this one
Part of
Memorial Med Ctr Amb

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/memmed-a4c532a6
  • Direct secure messaging: mmrhc@mmcportlavaca.hin.us

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Erin Clevenger Individual W-2 Managing EmployeeAd; Apr 1, 2025 100%
Operational/Managerial Control Apr 1, 2025 100%

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Memorial Medical CenterPort Lavaca, TX, CCN 451356 Hospital Operational/Managerial Control (100%) Jan 1, 1966
Memorial Medical CenterPort Lavaca, TX, CCN 45Z356 Hospital Operational/Managerial Control (100%) Dec 31, 2021
Golden Creek Healthcare and Rehabilitation CenterNavasota, TX, CCN 676097 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Lavaca Bay Nursing and Rehabilitation CenterPort Lavaca, TX, CCN 676481 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Mar 4, 2020
Mar 4, 2020
Feb 27, 2025
Tuscany VillagePearland, TX, CCN 676201 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2020

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1053964742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779793025",
            "telephone_number": "361-552-0325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 N VIRGINIA ST FL 2",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779793025",
            "telephone_number": "361-552-0379",
            "fax_number": "361-500-6904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL MEDICAL CENTER",
        "enumeration_date": "2019-07-22",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "CLEVENGER",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "361-552-6713"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmrhc@mmcportlavaca.hin.us",
            "affiliation": "N",
            "address_1": "815 N Virginia St Fl 2",
            "city": "Port Lavaca",
            "state": "TX",
            "country_code": "US",
            "postal_code": "779793025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Memorial Medical Clinic Hospital Campus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Memorial Medical Clinic Hospital Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Lavaca, TX

Sources for this page

Verify at the official NPI Registry.