Provider Demographics
NPI:1497731426
Name:MEMORIAL SPECIALTY HOSPITAL
Entity Type:Organization
Organization Name:MEMORIAL SPECIALTY HOSPITAL
Other - Org Name:MEMORIAL SPECIALTY HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-634-8111
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:MEMORIAL SPECIALTY HOSPITAL
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75902-1447
Mailing Address - Country:US
Mailing Address - Phone:936-634-8111
Mailing Address - Fax:936-639-7976
Practice Address - Street 1:1201 FRANK STREET
Practice Address - Street 2:STE D
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:936-639-7976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000691284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH045017878Medicaid
TX452031Medicare ID - Type Unspecified