Provider Demographics
NPI:1730407065
Name:CLEAR LAKE ANESTHESIA SERVICES
Entity type:Organization
Organization Name:CLEAR LAKE ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:VERON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:832-858-0253
Mailing Address - Street 1:3106 SEA CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-1680
Mailing Address - Country:US
Mailing Address - Phone:281-326-0253
Mailing Address - Fax:
Practice Address - Street 1:1015 MEDICAL CENTER BLVD STE 2100
Practice Address - Street 2:DOING BUSINESS AT CORM
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4081
Practice Address - Country:US
Practice Address - Phone:281-557-5837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty