Provider Demographics
NPI:1891210639
Name:USA EMERGENCY CENTERS - CLEAR LAKE, LLC
Entity Type:Organization
Organization Name:USA EMERGENCY CENTERS - CLEAR LAKE, LLC
Other - Org Name:ALLY MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:GOVERNING BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-451-0911
Mailing Address - Street 1:5525 BURNET RD STE A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-1646
Mailing Address - Country:US
Mailing Address - Phone:512-451-0911
Mailing Address - Fax:281-280-0026
Practice Address - Street 1:3351 CLEAR LAKE CITY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77059-2513
Practice Address - Country:US
Practice Address - Phone:281-280-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-12
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160329261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160329OtherFREESTANDING EMERGENCY CENTER LICENSE