Provider Demographics
NPI:1245755933
Name:CLEAR CREEK EMERGENCY ROOM LLC
Entity Type:Organization
Organization Name:CLEAR CREEK EMERGENCY ROOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HORTENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-978-6353
Mailing Address - Street 1:2320 S SHEPHERD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-7014
Mailing Address - Country:US
Mailing Address - Phone:713-526-2320
Mailing Address - Fax:713-526-2322
Practice Address - Street 1:3725 E LEAGUE CITY PARKWAY, SUITE 150
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573
Practice Address - Country:US
Practice Address - Phone:713-526-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160352207P00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1144294505OtherTHANG NGUYEN
TX1295757060OtherSUZANNA CRUZ
TX1245755933OtherCLEAR CREEK EMERGENCY ROOM LLC
TX1669457404OtherBLAKE CHAMBERLAIN
TX160352OtherDEPARTMENT OF STATE HEALTH SERVICES REGULATORY LICENSING UNIT