| Organization Name: | MEMORIAL MEDICAL CLINIC |
| NPI Number: | 1578960647 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE CHRIS MOORE (CFO) |
| Mailing Address: | 815 N Virginia St Port Lavaca |
| State: | TX US |
| Postal Code: | 779793025 |
| Phone Number: | 3615520224 |
| Fax Number: | 3615520220 |
| NPI Enumeration Date: | 12/04/2014 |
| NPI Last Update Date: | 12/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NC0060X |
| License Number: | 000487 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Critical Access |
| Taxonomy Definition: | |