Provider Demographics
NPI:1073136628
Name:PROVIDENCE ER OF CLEARLAKE, PLLC
Entity Type:Organization
Organization Name:PROVIDENCE ER OF CLEARLAKE, PLLC
Other - Org Name:HOUSTON MEDICAL ER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-453-7916
Mailing Address - Street 1:5037B FM 2920 RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3114
Mailing Address - Country:US
Mailing Address - Phone:281-453-7916
Mailing Address - Fax:
Practice Address - Street 1:1351 CLEARLAKE CITY BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062
Practice Address - Country:US
Practice Address - Phone:713-344-1514
Practice Address - Fax:713-344-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care