Memorial Medical Center

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MEMORIAL MEDICAL CENTER

Practice address

5665 Creekside Forest Dr
The Woodlands, TX 77389-4969

Phone

(281) 255-8180

NPI assigned

Jan 2, 2015

Organization subpart

No

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

Authorized official

Name

Jason Anglin

Title

Ceo

Phone

(361) 552-6713

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Broadmoor at Creekside Park Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Memorial Medical Center

  • Rural Health Clinic/Center
  • Port Lavaca, TX
  • NPI 1497153589

  Member Of

  NPD member

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Teresa T Guerrero, M.D.

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1073723995
  NPD (past)
• Abbas H Jafri, MD

  • Internal Medicine Physician
  • Spring, TX
  • NPI 1891798161
  NPD (past)

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

{
    "created_epoch": "1420156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440547200000",
    "number": "1669860433",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5665 CREEKSIDE FOREST DR",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773894969",
            "telephone_number": "281-255-8180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-02",
        "last_updated": "2015-08-26",
        "status": "A",
        "authorized_official_last_name": "ANGLIN",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "361-552-6713"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CCN",
            "identifier": "67-6357",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Broadmoor at Creekside Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ilyas M Memon, MD
• Memorial Hermann Health System
• Memorial Hermann Surgery Center - the Woodlands, LLP
• Memorial Hermann Surgery Center Pinecroft, LLC
• Memorial Hermann Surgery Center Woodlands Parkway, LLC
• Memorial Multispecialty Associates
• Memorial TC LLC
• Janice Mercilliott, CPNP-PC
• Jennifer Meredith, LCSW
• Meredith Mermigas, PHARMD

• Skilled Nursing Facility in The Woodlands, TX
• Providers in The Woodlands, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2015; 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.