Provider Demographics
NPI:1992745368
Name:MEMORIAL MEDICAL CENTER OF EAST TEXAS
Entity type:Organization
Organization Name:MEMORIAL MEDICAL CENTER OF EAST TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO MEMORIAL MEDICAL CENTER EAST TX
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-639-3036
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:936-639-3036
Mailing Address - Fax:936-639-3064
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:936-639-3036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL MEDICAL CENTER OF EAST TEXAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00H24NOtherBCBS
TX00H24NOtherBCBS
TX00H24NMedicare PIN