| NPI | 1053964742 |
|---|---|
| NPI Type | NPI-2 Organization |
| Status | Active |
| Enumeration Date | 2019-07-22 |
| Last Updated | 2025-09-19 |
| Authorized Official | Erin Clevenger CEO Phone: 3615526713 |
| Mailing Address | 815 N Virginia St Port Lavaca, TX 77979-3025 United States Phone: (361) 552-0325 📍 View Map |
| Primary Practice Address | 815 N Virginia St Fl 2 Port Lavaca, TX 77979-3025 United States Phone: (361) 552-0379 | Fax: (361) 500-6904 📍 View Map |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| No | 207Q00000X – Family Medicine | — | — |
| No | 363LF0000X – Nurse Practitioner, Family | — | — |
| No | 208D00000X – General Practice | — | — |
| No | 207V00000X – Obstetrics & Gynecology | — | — |
| Yes | 261QR1300X – Clinic/Center, Rural Health | — | — |
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About NPI 1053964742
Memorial Medical Center is an organization registered in the CMS NPPES NPI Registry with NPI number 1053964742. The primary specialty listed is Clinic/Center, Rural Health. The organization is located in Port Lavaca, TX. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2019-07-22. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1053964742?
NPI 1053964742 belongs to Memorial Medical Center, a Clinic/Center, Rural Health in Port Lavaca, TX. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.
Is NPI 1053964742 active?
The current status of NPI 1053964742 in the NPPES registry is Active. The record was last updated on 2025-09-19.
What specialty is NPI 1053964742?
NPI 1053964742 is classified under the taxonomy Clinic/Center, Rural Health. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1053964742?
You can verify NPI 1053964742 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1053964742?
The primary practice address on file for NPI 1053964742 is 815 N Virginia St Fl 2, Port Lavaca, TX 77979-3025. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1053964742 issued?
NPI 1053964742 was first issued (enumerated) on 2019-07-22. The NPPES record was last updated on 2025-09-19.
Practice Location Map
Memorial Medical Center is located at 815 N Virginia St Fl 2, Port Lavaca, TX. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Memorial Medical Center. All records sourced from the CMS NPPES registry.