Provider Demographics
NPI:1265696470
Name:CLEAR LAKE-HOUSTON ELECTROPHYSIOLOGY, P.A.
Entity type:Organization
Organization Name:CLEAR LAKE-HOUSTON ELECTROPHYSIOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGGARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:NATTAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-338-0750
Mailing Address - Street 1:PO BOX 3014
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3014
Mailing Address - Country:US
Mailing Address - Phone:281-338-0750
Mailing Address - Fax:
Practice Address - Street 1:250 BLOSSOM ST STE 280
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4243
Practice Address - Country:US
Practice Address - Phone:281-338-0750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX392708593Medicare PIN