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General NPI Number Information
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NPI Number | 1184955510
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Entity Type | Organization
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Legal Business Name | CLEAR LAKE LABORATORY LLC
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 202 N TEXAS AVE SUITE 200
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City | WEBSTER
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State | TX
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Zip | 77598-4967
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Country | US
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Telephone | 281-824-5442
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Fax | 281-557-7959
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Provider Business Mailing Address
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Address Line | 202 N TEXAS AVE SUITE 200
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City | WEBSTER
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State | TX
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Zip | 77598-4967
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Country | US
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Telephone | 281-824-5442
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Fax | 281-557-7959
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHAMMAD J BABA
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Credential | MD
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Telephone | 281-824-5442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | TX
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