Provider Demographics
NPI:1457454431
Name:MEMORIAL HEALTH SYSTEM OF EAST TEXAS
Entity Type:Organization
Organization Name:MEMORIAL HEALTH SYSTEM OF EAST TEXAS
Other - Org Name:CHI ST LUKE'S HEALTH MEMORIAL LUFKIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-634-8111
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:MEMORIAL MEDICAL CENTER REHAB
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75902-3357
Mailing Address - Country:US
Mailing Address - Phone:936-634-8111
Mailing Address - Fax:936-639-7827
Practice Address - Street 1:1201 W FRANK
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-634-8111
Practice Address - Fax:936-639-7827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139172414Medicaid
45T211Medicare ID - Type Unspecified
TX45T211Medicare Oscar/Certification