Provider Demographics
NPI:1003899055
Name:MEMORIAL ENDOSCOPY CENTER, LP
Entity Type:Organization
Organization Name:MEMORIAL ENDOSCOPY CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-468-9200
Mailing Address - Street 1:1233 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6453
Mailing Address - Country:US
Mailing Address - Phone:713-468-9200
Mailing Address - Fax:713-465-4029
Practice Address - Street 1:1233 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6453
Practice Address - Country:US
Practice Address - Phone:713-468-9200
Practice Address - Fax:713-465-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007907261QA1903X, 261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00100956OtherRRMCR
TX1646895-01Medicaid
TX7252420OtherAETNA
TXHH1592OtherBCBS
TXP00100956OtherRRMCR