Provider Demographics
NPI:1710985098
Name:MEMORIAL HERMANN HEALTH SYSTEM
Entity Type:Organization
Organization Name:MEMORIAL HERMANN HEALTH SYSTEM
Other - Org Name:TIRR MEMORIAL HERMANN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP, CAO & CHIEF LEGAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-242-2709
Mailing Address - Street 1:PO BOX 301208
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1208
Mailing Address - Country:US
Mailing Address - Phone:713-338-4127
Mailing Address - Fax:713-338-4158
Practice Address - Street 1:1333 MOURSUND ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3405
Practice Address - Country:US
Practice Address - Phone:713-799-5000
Practice Address - Fax:713-338-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0400X
TX000164283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX337433201Medicaid
TX138003202Medicaid
TX138003209Medicaid
TX337433207Medicaid
TX138003205Medicaid
TX138003207Medicaid
TXHH0696OtherBLUE CROSS
TX138003201Medicaid
TX4538530OtherAETNA INSURANCE
TX138003210Medicaid
TX453025Medicare Oscar/Certification