Basic Information
| Provider Information | |||||||||
| NPI: | 1114224151 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHCA CLEAR LAKE LP | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HCA HOUSTON HEALTHCARE CLEAR LAKE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813322511 | ||||||||
| FaxNumber: | 2813383352 | ||||||||
| Practice Location | |||||||||
| Address1: | 6801 EMMETT F LOWRY EXPY | ||||||||
| Address2: | |||||||||
| City: | TEXAS CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775912500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813322511 | ||||||||
| FaxNumber: | 2813383352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2011 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | SLIWINSKI | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2813383110 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHCA CLEAR LAKE LP | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | Y | Hospital Units | Psychiatric Unit |
No ID Information.