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General NPI Number Information
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NPI Number | 1922513134
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Entity Type | Organization
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Legal Business Name | CLEARLAKE IMAGING LLC
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 202 N TEXAS AVE STE 400
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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 | 832-667-8132
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Fax | 281-643-0440
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Provider Business Mailing Address
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Address Line | 202 N TEXAS AVE STE 400
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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 | 832-667-8132
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Fax | 281-643-0440
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. NIDHI SHARMA
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Credential |
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Telephone | 832-667-8132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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