1275817504 NPI number — MEMORIAL HERMANN COMMUNITY BENEFIT CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275817504 NPI number — MEMORIAL HERMANN COMMUNITY BENEFIT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL HERMANN COMMUNITY BENEFIT CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEMORIAL HERMANN HEALTH CENTERS FOR SCHOOLS--WAVE CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275817504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 FROSTWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77024-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-338-5983
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77587-4252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-946-7461
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PARET
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF COMMUNITY BENEFIT OFFICER
Authorized Official Telephone Number:
713-338-5983

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  F0899 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: F0889 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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