Provider Demographics
NPI:1699712562
Name:CARDIOVASCULAR ASSOCIATES OF CLEAR LAKE, PA
Entity type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF CLEAR LAKE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSELMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-554-8780
Mailing Address - Street 1:PO BOX 58776
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8776
Mailing Address - Country:US
Mailing Address - Phone:281-554-8780
Mailing Address - Fax:281-554-8780
Practice Address - Street 1:450 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 550
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4234
Practice Address - Country:US
Practice Address - Phone:281-554-8780
Practice Address - Fax:281-554-8780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG22753Medicare UPIN
TXH17196Medicare UPIN
TXB27135Medicare UPIN
TXH59016Medicare UPIN