Provider Demographics
NPI:1982099255
Name:MEMORIAL HERMANN MEDICAL GROUP
Entity Type:Organization
Organization Name:MEMORIAL HERMANN MEDICAL GROUP
Other - Org Name:MEMORIAL HERMANN MEDICAL GROUP URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-338-4523
Mailing Address - Street 1:909 FROSTWOOD DR
Mailing Address - Street 2:SUITE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-4523
Mailing Address - Fax:713-338-5500
Practice Address - Street 1:909 FROSTWOOD DR
Practice Address - Street 2:SUITE 1.100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2301
Practice Address - Country:US
Practice Address - Phone:713-338-4523
Practice Address - Fax:713-338-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid