Provider Demographics
NPI:1144548140
Name:CLEAR LAKE HEALTHCARE
Entity type:Organization
Organization Name:CLEAR LAKE HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:281-332-4555
Mailing Address - Street 1:9 PROFESSIONAL PARK DR.
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598
Mailing Address - Country:US
Mailing Address - Phone:281-332-4555
Mailing Address - Fax:281-332-8439
Practice Address - Street 1:9 PROFESSIONAL PARK DR.
Practice Address - Street 2:SUITE B
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:281-332-4555
Practice Address - Fax:281-332-8439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center