Healthcare Provider Details

I. General information

NPI: 1528583366
Provider Name (Legal Business Name): USA EMERGENCY PHYSICIANS CLEAR LAKE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2017
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 CLEAR LAKE CITY BLVD STE 100
HOUSTON TX
77059-2513
US

IV. Provider business mailing address

5525 BURNET RD STE A
AUSTIN TX
78756-1646
US

V. Phone/Fax

Practice location:
  • Phone: 281-280-0911
  • Fax:
Mailing address:
  • Phone: 512-451-0911
  • Fax: 281-280-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JARED T SHAHAN
Title or Position: GOVERNING BOARD MEMBER
Credential: MD
Phone: 512-451-0911