Provider Demographics
NPI:1306317367
Name:MEMORIAL ALLERGY & ASTHMA, PLLC
Entity type:Organization
Organization Name:MEMORIAL ALLERGY & ASTHMA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:DILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-485-4816
Mailing Address - Street 1:9525 KATY FWY STE 142
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1433
Mailing Address - Country:US
Mailing Address - Phone:713-485-4816
Mailing Address - Fax:713-485-4156
Practice Address - Street 1:9525 KATY FWY STE 142
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1433
Practice Address - Country:US
Practice Address - Phone:713-485-4816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1528387735Medicaid