Basic Information
| Provider Information | |||||||||
| NPI: | 1962438028 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEMORIAL HERMANN HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 301162 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753031162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133384127 | ||||||||
| FaxNumber: | 7133384158 | ||||||||
| Practice Location | |||||||||
| Address1: | 23920 KATY FWY STE 460 | ||||||||
| Address2: | |||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774940882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133387300 | ||||||||
| FaxNumber: | 7133387303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | ANDREWS | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR PATIENT BUSINESS SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 7133387413 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 007859 | TX | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 023755401 | 05 | TX | MEDICAID |