Clear Lake Medical Clinic | |
450 W Medical Center Blvd Suite 203 Webster TX 77598-4234 | |
(832) 906-2500 | |
(832) 906-2501 |
Full Name | Clear Lake Medical Clinic |
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Speciality | Clinic/Center |
Location | 450 W Medical Center Blvd, Webster, Texas |
Authorized Official Name and Position | Manan S Shukla (PRESIDENT) |
Authorized Official Contact | 6123061509 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Clear Lake Medical Clinic 450 W Medical Center Blvd Suite 203 Webster TX 77598-4234 Ph: (832) 906-2500 | Clear Lake Medical Clinic 450 W Medical Center Blvd Suite 203 Webster TX 77598-4234 Ph: (832) 906-2500 |
NPI Number | 1225562887 |
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Provider Enumeration Date | 04/19/2017 |
Last Update Date | 05/02/2017 |
Medicare PECOS PAC ID | 7810266715 |
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Medicare Enrollment ID | O20170710001044 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225562887 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | N9300 (Texas) | Primary |
Provider Name | Manan S Shukla |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1194794610 PECOS PAC ID: 3577544048 Enrollment ID: I20121023000813 |
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