Provider Demographics
NPI:1396746129
Name:MEMORIAL HEALTH SYSTEM OF EAST TEXAS
Entity type:Organization
Organization Name:MEMORIAL HEALTH SYSTEM OF EAST TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-639-7661
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:
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:936-639-7827
Practice Address - Street 1:1201 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3357
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:2005-08-02
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000129261QA1903X
273Y00000X, 282N00000X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No273Y00000XHospital UnitsRehabilitation Unit
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH0426OtherBCBS
TX139172412Medicaid
TXHH0426OtherBCBS
TX450211Medicare Oscar/Certification