Provider Demographics
NPI:1639515091
Name:CLEAR LAKE OBGYN, PLLC
Entity Type:Organization
Organization Name:CLEAR LAKE OBGYN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ECHO
Authorized Official - Middle Name:BREANN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-557-0300
Mailing Address - Street 1:251 W MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4242
Mailing Address - Country:US
Mailing Address - Phone:281-557-0300
Mailing Address - Fax:281-557-3301
Practice Address - Street 1:251 W MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4242
Practice Address - Country:US
Practice Address - Phone:281-557-0300
Practice Address - Fax:281-557-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty