Providence ER of Clearlake, PLLC

Primary specialty

Emergency Care Clinic/CenterTaxonomy code 261QE0002X

Legal business name

PROVIDENCE ER OF CLEARLAKE, PLLC

Doing business as

Houston Medical ER

Practice address

1351 Clearlake City Blvd
Houston, TX 77062

Phone

(713) 344-1514

Fax

(713) 344-1433

NPI assigned

May 18, 2020

Last updated

Sep 8, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Minh Nguyen, MD

Title

Owner

Phone

(281) 453-7916

Specialties & licenses 1

Addresses

Other names 1

• Houston Medical ER Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1073136628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5037B FM 2920 RD",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773883114",
            "telephone_number": "281-453-7916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 CLEARLAKE CITY BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77062",
            "telephone_number": "713-344-1514",
            "fax_number": "713-344-1433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2306 Rayford Rd",
            "address_purpose": "LOCATION",
            "city": "Spring",
            "state": "TX",
            "postal_code": "773861707",
            "country_code": "US",
            "telephone_number": "832-482-9595",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE ER OF CLEARLAKE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-18",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "MINH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "281-453-7916",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Houston Medical ER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark Phillip Provenzano, M.D.
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• Emergency Care Clinic/Center in Houston, TX
• Providers in Houston, TX by specialty
• Emergency Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.