Provider Demographics
NPI:1831271188
Name:CLEAR LAKE INTEGRATED HEALTH CARE
Entity type:Organization
Organization Name:CLEAR LAKE INTEGRATED HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PUSHPA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-338-1815
Mailing Address - Street 1:15514 CONIFER BAY CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059
Mailing Address - Country:US
Mailing Address - Phone:281-338-1815
Mailing Address - Fax:281-316-2539
Practice Address - Street 1:7 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4123
Practice Address - Country:US
Practice Address - Phone:281-338-1815
Practice Address - Fax:281-316-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH46390Medicare UPIN
TX00169WMedicare ID - Type Unspecified