Provider Demographics
NPI:1487823126
Name:MEMORIAL HERMANN HH
Entity Type:Organization
Organization Name:MEMORIAL HERMANN HH
Other - Org Name:MEMORIAL HERMANN HH
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORINDA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:BRACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-596-4623
Mailing Address - Street 1:PO BOX 201016
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-1016
Mailing Address - Country:US
Mailing Address - Phone:713-596-4663
Mailing Address - Fax:
Practice Address - Street 1:7500 BEECHNUT ST
Practice Address - Street 2:SUITE 320
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-4335
Practice Address - Country:US
Practice Address - Phone:713-596-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007860251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457741Medicare Oscar/Certification