Active NPI
Memorial Medical Clinic
- Family Medicine Physician
- Port Lavaca, TX
National Provider Identifier
1639510092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- MEMORIAL MEDICAL CLINIC
- Practice address
- 815 N Virginia St
Port Lavaca, TX 77979-3025 - Phone
- (361) 552-0325
- Fax
- (361) 553-7815
- NPI assigned
- Jul 15, 2013
- Last updated
- Jul 15, 2013
- Organization subpart
- Yes
- Parent organization
- MEMORIAL MEDICAL CENTER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Danette Bethany
- Title
- Director
- Phone
- (361) 552-6713
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 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) 552-0325
National Provider Directory
National Provider Directory- Part of
- Memorial Med Ctr Amb
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373846400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1373846400000",
"number": "1639510092",
"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",
"fax_number": "361-553-7815"
},
{
"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": "361-552-0325",
"fax_number": "361-553-7815"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEMORIAL MEDICAL CLINIC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MEMORIAL MEDICAL CENTER",
"enumeration_date": "2013-07-15",
"last_updated": "2013-07-15",
"status": "A",
"authorized_official_last_name": "BETHANY",
"authorized_official_first_name": "DANETTE",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "361-552-6713",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"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 Jul 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.