Provider Demographics
NPI:1740233782
Name:MEMORIAL HERMANN HEALTH SYSTEM
Entity Type:Organization
Organization Name:MEMORIAL HERMANN HEALTH SYSTEM
Other - Org Name:MEMORIAL HERMANN MEMORIAL CITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP- CAO- CHIEF LEGAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:C
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 1:921 GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2501
Practice Address - Country:US
Practice Address - Phone:713-242-3000
Practice Address - Fax:713-338-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X
TX000302282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020934801Medicaid
TX022519501Medicaid
TX450610Medicare Oscar/Certification