OrganizationActive
Memorial Medical Clinic
NPI 1639510092 · Family Medicine Physician · Port Lavaca, TX
Provider details
- NPI number
- 1639510092
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Memorial Medical Center
- Organization subpart
- Yes
- Authorized official
- Danette Bethany, Director(361) 552-6713
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(77/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
815 N Virginia St
Port Lavaca, TX 77979-3025
Phone: (361) 552-0325
Fax: (361) 553-7815
Street-level locationGet directions
Mailing address
815 N Virginia St
Port Lavaca, TX 77979-3025
Registry dates
- Enumerated
- 2013-07-15
- Last updated
- 2013-07-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.