MEMORIAL MEDICAL CENTER
NPI 1104203181
Surgery in Port Lavaca, TX
NPI Status: Active since April 29, 2015
Contact Information
815 N VIRGINIA ST
PORT LAVACA, TX
ZIP 77979
Phone: (361) 552-6713
Fax: (361) 552-0220
- Organization
- Surgery
- Accepts Insurance
- CLIA Number: 45D0054055
- CLIA Cert. Type: Hospital
- CLIA Exp. Date: 04-11-2027
About MEMORIAL MEDICAL CENTER
This page provides the complete NPI Profile along with additional information for Memorial Medical Center, a provider established in Port Lavaca, Texas operating as a Surgery. The healthcare provider is registered in the NPI registry with number 1104203181 assigned on April 2015. The practitioner's primary taxonomy code is 208600000X. The provider is registered as an organization and their NPI record was last updated March 2026. Memorial Medical Center operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Erin Clevenger (Ceo)
- NPI
- 1104203181
- Provider Name
- MEMORIAL MEDICAL CENTER
- Entity Type
- Organization
- Location Address
- 815 N VIRGINIA ST PORT LAVACA, TX 77979
- Location Phone
- (361) 552-6713
- Location Fax
- (361) 552-0220
- Mailing Address
- 815 N VIRGINIA ST PORT LAVACA, TX 77979
- Mailing Phone
- (361) 552-6713
- Mailing Fax
- (361) 552-0220
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-29-2015
- Last Update Date
- 03-04-2026
- Code Navigator
A surgeon like Memorial Medical Center treats injuries, diseases, and deformities through surgical operations. A surgeon could correct physical deformities, repair bone and tissue, or perform preventive or elective surgeries. Surgeons also examine patients, perform and interpret diagnostic tests, and provide counsel on preventive healthcare.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Surgery
- Taxonomy Code
- 208600000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Advantage Bronze HMO? 204 - HMO
- Blue Advantage Bronze HMO? 301 - HMO
- Blue Advantage Bronze HMO? Standard - HMO
- Blue Advantage Gold HMO? 206 - HMO
- Blue Advantage Gold HMO? 603 - HMO
- Blue Advantage Gold HMO? Standard - HMO
- Blue Advantage Plus Bronze? 303 - POS
- Blue Advantage Plus Bronze? 305 - POS
- Blue Advantage Plus Bronze? Standard - POS
- Blue Advantage Plus Gold? 203 - POS
- Blue Advantage Plus Gold? 803 - POS
- Blue Advantage Plus Gold? Standard - POS
- Blue Advantage Plus Silver? 202 - POS
- Blue Advantage Plus Silver? 605 - POS
- Blue Advantage Plus Silver? Standard - POS
- Blue Advantage Security HMO? 200 - HMO
- Blue Advantage Silver HMO? 205 - HMO
- Blue Advantage Silver HMO? 801 - HMO
- Blue Advantage Silver HMO? Standard - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| T225 | OTHER (01) | TX | MEDICARE PART B |
| 137909103 | MEDICAID (05) | TX |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 45D0054055
- Facility Type
- Hospital
- Certificate Effective Date
- April 12, 2025
- Certificate Expiration Date
- April 11, 2027
- Laboratory Director
- BRYAN JANSSEN
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Memorial Medical Center after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
Reviews for MEMORIAL MEDICAL CENTER
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1104203181, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 49. The final step is to find the difference between that total and the next multiple of ten (50 - 49 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 49 is 50. The difference is the calculated check digit.
Other Providers at the Same Location
The following 16 providers are registered at the same or a nearby location.
PORT LAVACA, TX 77979
PORT LAVACA, TX 77979
PORT LAVACA, TX 77979
PORT LAVACA, TX 77979
PORT LAVACA, TX 77979
PORT LAVACA, TX 77979
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104203181, enumerated as an "organization" on April 29, 2015.
The provider is located at 815 N VIRGINIA ST PORT LAVACA, TX 77979 and the phone number is (361) 552-6713.
Surgery with taxonomy code 208600000X.
The provider might be accepting Accepts: Blue Cross and Blue Shield of Texas, Medicare and. Please consult your insurance carrier or call the provider to verify.
