Provider Demographics
NPI:1922513134
Name:CLEARLAKE IMAGING LLC
Entity Type:Organization
Organization Name:CLEARLAKE IMAGING LLC
Other - Org Name:CLEARLAKE IMAGING LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIDHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-667-8132
Mailing Address - Street 1:202 N TEXAS AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4967
Mailing Address - Country:US
Mailing Address - Phone:832-667-8132
Mailing Address - Fax:281-643-0440
Practice Address - Street 1:202 N TEXAS AVE STE 400
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4967
Practice Address - Country:US
Practice Address - Phone:832-667-8132
Practice Address - Fax:281-643-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology