Provider Demographics
NPI:1184644098
Name:CLEAR LAKE EMERGENCY MEDICAL CORPS
Entity Type:Organization
Organization Name:CLEAR LAKE EMERGENCY MEDICAL CORPS
Other - Org Name:CLEAR LAKE EMERGENCY MEDICAL CORPS.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-204-7794
Mailing Address - Street 1:16920 N TEXAS AVE STE C14
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4016
Mailing Address - Country:US
Mailing Address - Phone:832-615-8006
Mailing Address - Fax:281-488-3080
Practice Address - Street 1:951 FM 646 EAST
Practice Address - Street 2:SUITE A7
Practice Address - City:DICKINSON, TX 77539
Practice Address - State:TX
Practice Address - Zip Code:77539-4016
Practice Address - Country:US
Practice Address - Phone:281-204-7794
Practice Address - Fax:832-932-1576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010193416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX514783OtherBC/BS OF TEXAS
TX088228401Medicaid
TX088228401Medicaid
TX514783Medicare PIN