Provider Demographics
NPI:1376064295
Name:MEMORIAL VILLAGE EMERGENCY ROOM
Entity Type:Organization
Organization Name:MEMORIAL VILLAGE EMERGENCY ROOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MESVERO
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:281-501-2841
Mailing Address - Street 1:14520 MEMORIAL DR STE 4
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14520 MEMORIAL DR STE 4
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5415
Practice Address - Country:US
Practice Address - Phone:281-496-6837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty