Basic Information
| Provider Information | |||||||||
| NPI: | 1689951311 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHCA CLEAR LAKE LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6807 EMMETT F LOWRY EXPY | ||||||||
| Address2: | STE. 305 | ||||||||
| City: | TEXAS CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775912546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4099385461 | ||||||||
| FaxNumber: | 4099385001 | ||||||||
| Practice Location | |||||||||
| Address1: | 6807 EMMETT F LOWRY EXPY | ||||||||
| Address2: | STE. 305 | ||||||||
| City: | TEXAS CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775912546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4099385461 | ||||||||
| FaxNumber: | 4099385001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2011 | ||||||||
| LastUpdateDate: | 11/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | SLIWINSKI | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4099385461 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Midwife |
No ID Information.