MEMORIAL MEDICAL CENTER (NPI# 1104203181) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104203181 |
| Entity Type | Organization |
| Organization Name | MEMORIAL MEDICAL CENTER |
| Practice Address |
815 N Virginia St Port Lavaca TX 77979-3025 |
| Practice Telephone | 3615526713 |
| Practice Fax Number | 3615520220 |
| Mailing Telephone | 3615526713 |
| Mailing Fax Number | 3615520220 |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2015-05-22 |
| Authorized Official Name | MR. JASON ANGLIN (CEO) |
| Authorized Official Telephone | 3615526713 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 137909103 | 05 | |
| TX | MEDICARE PART B | T225 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538719836 | Memorial Medical Center | Nursing Care | 118 Trinity Shores Drive, Port Lavaca, TX 77979 | 2019-09-18 |
| 1497153589 | Memorial Medical Center | Family Medicine | 1016 N. Virginia St., Port Lavaca, TX 77979-0000 | 2014-12-05 |
| 1588075964 | Memorial Medical Center | Skilled Nursing Facility | 2100 Dove Crossing Ln, Navasota, TX 77868-5247 | 2014-05-19 |
| 1275717894 | Memorial Medical Center | Skilled Nursing Facility | 2750 Miller Ranch Rd, Pearland, TX 77584-9763 | 2007-12-18 |
| 1679549968 | Memorial Medical Center | Audiologist | 644 North Second Street, Springfield, IL 62781-0001 | 2006-02-27 |
| 1124099098 | Memorial Medical Center | General Acute Care Hospital | 701 N !st St, Mab 528, Springfield, IL 62781-0001 | 2006-01-30 |
| 1922092790 | Memorial Medical Center | Skilled Nursing Facility | 1008 Enterprise Blvd, Rockport, TX 78382-3201 | 2005-09-07 |
| 1568017481 | Memorial Medical Center | Clinic/Center | 701 N 1st St, Springfield, IL 62781-0001 | 2019-08-07 |
| 1053964742 | Memorial Medical Center | Orthopaedic Surgery | 815 N Virginia St, Port Lavaca, TX 77979-3025 | 2019-07-22 |
| 1164954806 | Memorial Medical Center | Internal Medicine | 701 N 1st St, Mailbox 95, Springfield, IL 62781-0001 | 2017-03-31 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MEMORIAL MEDICAL CENTER | 8260 Atlee Rd Ste 1203, Mechanicsville, VA 23116-1844 |
| System for Award Management (SAM) Entities | MEMORIAL MEDICAL CENTER INC | 1615 Maple Ln, Ashland, WI 54806-3610 |
| System for Award Management (SAM) Entities | MEMORIAL MEDICAL CENTER OF EAST TEXAS | 1201 W Frank Ave, Lufkin, TX 75904-3357 |
| Street Address |
815 N VIRGINIA ST |
| City | PORT LAVACA |
| State | TX |
| Zip Code | 77979-3025 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609870161 | William J Crowley IIi | Family Medicine | 815 N Virginia St, Port Lavaca, TX 77979-3025 | 2005-06-11 |
| 1134776545 | Kristi Boyd | Nurse Practitioner | 815 N Virginia St, Port Lavaca, TX 77979-3025 | 2019-08-20 |
| 1053964742 | Memorial Medical Center | Orthopaedic Surgery | 815 N Virginia St, Port Lavaca, TX 77979-3025 | 2019-07-22 |
| 1750811733 | Penny Goulden | Physical Therapist | 815 N Virginia St, Port Lavaca, TX 77979 | 2017-06-13 |
| 1922546936 | Ess of Port Lavaca LLC | Emergency Medicine | 815 N Virginia St, Port Lavaca, TX 77979-3025 | 2017-02-09 |
| 1669857157 | Traci Shefcik | Nurse Practitioner | 815 N Virginia St, Port Lavaca, TX 77979-3025 | 2015-07-24 |
| 1073997524 | Courtne Thurlkill | Nurse Practitioner | 815 N Virginia St, Port Lavaca, TX 77979-3025 | 2015-07-15 |
| 1578960647 | Memorial Medical Clinic | General Acute Care Hospital | 815 N Virginia St, Port Lavaca, TX 77979-3025 | 2014-12-04 |
| 1366866477 | Victoria Professional Medical Consultants, LLC | Emergency Medicine | 815 N Virginia St, Port Lavaca, TX 77979-3025 | 2014-02-10 |
| 1639510092 | Memorial Medical Clinic | Family Medicine | 815 N Virginia St, Port Lavaca, TX 77979-3025 | 2013-07-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538719836 | Memorial Medical Center | Nursing Care | 118 Trinity Shores Drive, Port Lavaca, TX 77979 | 2019-09-18 |
| 1972083475 | Kelly Leigh Meyer | Occupational Therapy Assistant | Port Lavaca Nursing and Rehabilitation Center, 524 Village Rd, Port Lavaca, TX 77979 | 2018-08-15 |
| 1679943393 | Vrinda Mohunta | Dentist | 204 Tx-35, Port Lavaca, TX 77979 | 2015-10-07 |
| 1770999344 | Smile Experts Pllc | Dentist | 204 State Hwy 35 South, Port Lavaca, TX 77979 | 2014-07-03 |
| 1083927636 | Calhoun Home Health, LLC | Home Health | 1300 N Virginia St Ste 111, Port Lavaca, TX 77979 | 2010-07-23 |
| 1740423490 | Diana E. Garcia | Case Manager/Care Coordinator | 3272 U.S. Hwy 87, Port Lavaca, TX 77979 | 2009-04-10 |
| 1982844940 | Gillian V. Kwi | Dentist | 1112 Half League Rd, Port Lavaca, TX 77979 | 2009-03-03 |
| 1003054057 | Ngale Ndiva Mongoh | Pharmacist | 325 S. Hwy. 35 By Pass, Port Lavaca, TX 77979 | 2009-01-29 |
| 1326248592 | Nichole Lynn Bruno | Nurse Practitioner | 1300 N. Virginia Street, Port Lavaca, TX 77979 | 2007-07-24 |
| 1518168855 | Calhoun County Senior Citizens Assoc. Inc. | Home Delivered Meals | 2104 W Austin St., Port Lavaca, TX 77979 | 2007-05-31 |
| Find all providers in zip 77979 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972110971 | Metroplex Surgical Institute Pllc | Surgery | 2937 Lago Vista Ln, Rockwall, TX 75032-5466 | 2020-09-24 |
| 1881209708 | Preva Surgical Partners Cypress LLC | Surgery | 13114 Fm 1960 Rd W Ste 118, Houston, TX 77065-5590 | 2020-09-09 |
| 1063021749 | Brooke Nicole Harris | Surgery | 355 E Vista Ridge Mall Dr Apt 4933, Lewisville, TX 75067-4024 | 2020-07-28 |
| 1609484872 | Deepak Dev Vivekanandan | Surgery | 7703 Floyd Curl Dr # Mc-7742, San Antonio, TX 78229-3901 | 2020-07-14 |
| 1760009195 | Tomball Surgical Assistant Service LLC | Surgery | 18220 Tomball Pkwy # 249, Houston, TX 77070-4347 | 2020-07-01 |
| 1174147086 | North Texas General Surgery Pllc | Surgery | 1600 Coit Rd Ste 207, Plano, TX 75075-6172 | 2020-06-05 |
| 1619591690 | Expert Surgical, Pllc | Surgery | 3537 S I 35 E Ste 200, Denton, TX 76210-6814 | 2020-06-04 |
| 1831712314 | Merten Gene Pearson | Surgery | 7306 Sw 34th Ave Ste 6, Amarillo, TX 79121-1446 | 2020-05-19 |
| 1558983098 | Aleshia Yvette Toler-levi | Surgery | 405 Schley Ave, Orange, TX 77630-3503 | 2020-05-06 |
| 1508487570 | Somkenechi Ijeoma Ajene | Surgery | 301 University Boulevard, 6.136-b John Sealy Annex, Galveston, TX 77555-0534 | 2020-05-01 |
| Find all providers with the same taxonomy | ||||
| City | PORT LAVACA |
| Zip Code | 77979 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.