NPIMap

Organization Active NPI

Memorial Medical Clinic

  • Critical Access Hospital
  • Port Lavaca, TX
National Provider Identifier
1578960647
Registry record updated Dec 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
000487 Issued in TX
Legal business name
MEMORIAL MEDICAL CLINIC
Practice address
815 N Virginia St
Port Lavaca, TX 77979-3025
Phone
(361) 552-0224
Fax
(361) 552-0220
NPI assigned
Dec 4, 2014
Last updated
Dec 4, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2014

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

Authorized official

Name
Diane Chris Moore
Title
Cfo
Phone
(361) 552-0224

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 000487 TX Primary

Addresses

Primary practice location

815 N Virginia St
Port Lavaca, TX 77979-3025

Mailing address

815 N Virginia St
Port Lavaca, TX 77979-3025
Phone (361) 552-0224

Other identifiers 1

IdentifierTypeStateIssuer
137909111MedicaidTX

National Provider Directory

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

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1417651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417651200000",
    "number": "1578960647",
    "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": "361-552-0224",
            "fax_number": "361-552-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779793025",
            "telephone_number": "361-552-0224",
            "fax_number": "361-552-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-04",
        "last_updated": "2014-12-04",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "CHRIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "361-552-0224"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "TX",
            "license": "000487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137909111",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Lavaca, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2014; 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.