Provider Demographics
NPI:1003985102
Name:MEMORIAL HERMANN MEDICAL GROUP
Entity Type:Organization
Organization Name:MEMORIAL HERMANN MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP & PHYSICIAN CHIEF EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-338-5519
Mailing Address - Street 1:909 FROSTWOOD DR.
Mailing Address - Street 2:SUITE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-4523
Mailing Address - Fax:713-338-5500
Practice Address - Street 1:909 FROSTWOOD DR.
Practice Address - Street 2:SUITE 1.100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2301
Practice Address - Country:US
Practice Address - Phone:713-338-4523
Practice Address - Fax:713-338-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X849Medicare PIN
TX00Y376Medicare PIN
TX00X848Medicare PIN
TX00X978Medicare PIN