Healthcare Provider Details

I. General information

NPI: 1922513134
Provider Name (Legal Business Name): CLEARLAKE IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N TEXAS AVE STE 400
WEBSTER TX
77598-4967
US

IV. Provider business mailing address

202 N TEXAS AVE STE 400
WEBSTER TX
77598-4967
US

V. Phone/Fax

Practice location:
  • Phone: 832-667-8132
  • Fax: 281-643-0440
Mailing address:
  • Phone: 832-667-8132
  • Fax: 281-643-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. NIDHI SHARMA
Title or Position: OFFICE MANAGER
Credential:
Phone: 832-667-8132