Provider Demographics
NPI:1790773497
Name:CLEAR CREEK CLINIC,P.A.
Entity Type:Organization
Organization Name:CLEAR CREEK CLINIC,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-332-6573
Mailing Address - Street 1:302 HIGHWAY 3 S
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3755
Mailing Address - Country:US
Mailing Address - Phone:281-332-6573
Mailing Address - Fax:281-332-7409
Practice Address - Street 1:302 HIGHWAY 3 S
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3755
Practice Address - Country:US
Practice Address - Phone:281-332-6573
Practice Address - Fax:281-332-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty