CLEAR LAKE ENT, P.A (NPI# 1629267752) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629267752 |
| Entity Type | Organization |
| Organization Name | CLEAR LAKE ENT, P.A |
| Practice Address |
18100 Saint John Dr Suite 240 Houston TX 77058-3631 |
| Mailing Address |
Po Box 580451 Lock Box 157102 Houston TX 77258-0451 |
| Practice Telephone | 2813357755 |
| Practice Fax Number | 2813357766 |
| Mailing Telephone | 2813357755 |
| Mailing Fax Number | 2813357766 |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2007-10-15 |
| Authorized Official Name | DR. ALFREDO JIMENEZ (OWNER) |
| Authorized Official Telephone | 2813357755 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | J4653 | TX | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | AMERIGROUP | 10023864 | 01 |
| TX | BCBS | 8K6340 | 01 |
| TX | UPIN | F68110 | 01 |
| TX | MCARE | 0029KV | 01 |
| Street Address |
18100 SAINT JOHN DR SUITE 240 |
| City | HOUSTON |
| State | TX |
| Zip Code | 77058-3631 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821098526 | Richard Ehlers | Surgery | 18100 Saint John Dr, Ste. 320, Houston, TX 77058-3631 | 2005-07-26 |
| 1215386057 | Clear Lake Facial Aesthetic & Reconstructive Surgery | Otolaryngology | 18100 Saint John Dr, Suite 240, Houston, TX 77058-3631 | 2016-06-11 |
| 1700045606 | Mehrad Adibi | Urology | 18100 Saint John Dr, Houston, TX 77058-3631 | 2008-06-05 |
| 1245447531 | Jenna Lee Tubbs | Specialist/Technologist | 18100 Saint John Dr, Suite 100, Houston, TX 77058-3631 | 2007-05-17 |
| 1760605539 | Alfred Tennyson Mitchell | Plastic Surgery | 18100 Saint John Dr, Suite 220, Houston, TX 77058-3631 | 2007-04-10 |
| 1376679118 | Margarita Mallari-brumlow | Physical Therapist | 18100 Saint John Dr, Houston, TX 77058-3631 | 2007-02-26 |
| 1730215583 | Jenna Lawless | Physical Therapist | 18100 Saint John Dr, Houston, TX 77058-3631 | 2007-02-26 |
| 1164570263 | Cathy Poerner Supak | Specialist/Technologist | 18100 Saint John Dr, Suite 100, Houston, TX 77058-3631 | 2007-01-08 |
| 1356424733 | Bay Area Hand Institute | Plastic Surgery | 18100 Saint John Dr, Suite 220, Houston, TX 77058-3631 | 2006-10-22 |
| 1366410318 | Maria Carmen Visus | Internal Medicine | 18100 Saint John Dr, 280, Houston, TX 77058-3631 | 2006-03-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699248807 | Jolly Joseph | Nurse Practitioner | 18300, Houston Methodist, Houston, TX 77058 | 2019-01-10 |
| 1700372992 | Jasmin Elise Auzenne | Audiologist | 17625 El Camino Real Ste 155, Houston, TX 77058 | 2018-07-10 |
| 1053801225 | Dialyspa Vii LLC | Clinic/Center | 1411 Bonner St., Houston, TX 77058 | 2018-05-14 |
| 1699263285 | Pneucare, LLC | Durable Medical Equipment & Medical Supplies | 1322 Space Park Dr Ste C120, Houston, TX 77058 | 2018-04-29 |
| 1972005189 | Limy Fernandus | Nurse Practitioner | 985 E Nasa Pkwy, Houston, TX 77058 | 2018-03-03 |
| 1033623616 | Sigi Paul | Nurse Practitioner | 1210 El Camino Village Dr., Houston, TX 77058 | 2017-11-19 |
| 1881107845 | Jennifer Elise Hobson | Counselor | 1322 Space Park Dr Ste B123, Houston, TX 77058 | 2017-11-13 |
| 1174035778 | Agrarian Wellness, LLC | Registered Nurse | 17000 El Camino Real Ste 209, Houston, TX 77058 | 2017-11-04 |
| 1013468073 | Cynthia Bandemer | Counselor | 17300 El Camino Real Ste 107d, Houston, TX 77058 | 2016-10-14 |
| 1043698533 | Hopewell Home Healthcare LLC | Nursing Care | 18090 Kings Row, Houston, TX 77058 | 2015-05-15 |
| Find all providers in zip 77058 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
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| 1588290761 | Jim Gigante | Specialist | 5607 Fountainbridge Ln, Houston, TX 77069-1917 | 2020-03-19 |
| 1043840044 | Valerie Pedraza | Specialist | 9802d Ella Blvd, Houston, TX 77038-3030 | 2020-01-19 |
| 1386200178 | Thaddieus A Reed | Specialist | 3605 Wilmington St, Houston, TX 77051-3248 | 2019-05-16 |
| 1437617545 | Wellness Institute of Neurodevelopment | Specialist | 5757 Woodway Dr Ste 190, Houston, TX 77057-1526 | 2019-03-07 |
| 1275098568 | Idoc Virtual Telehealth Texas | Specialist | 2311 W Main St, Houston, TX 77098-3218 | 2019-01-31 |
| 1326531708 | Houston Neurology Clinical & Diagnostic Consultants Company | Specialist | 1313 La Concha Ln Ste 130, Houston, TX 77054-1809 | 2018-06-11 |
| 1154840908 | Webster Diagnostics, Pllc | Specialist | 18333 Egret Bay Blvd Ste 200, Houston, TX 77058-3200 | 2017-09-13 |
| 1093242166 | Cns Medical Group | Specialist | 6238 Rietta St, Houston, TX 77016-4338 | 2017-05-18 |
| Find all providers in HOUSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.