Provider Demographics
NPI:1174199707
Name:OPTIMUM AMBULATORY HEALTH PLLC
Entity Type:Organization
Organization Name:OPTIMUM AMBULATORY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-461-1111
Mailing Address - Street 1:2409 FALCON PASS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-6276
Mailing Address - Country:US
Mailing Address - Phone:281-461-1111
Mailing Address - Fax:281-461-6860
Practice Address - Street 1:2409 FALCON PASS DR STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-6276
Practice Address - Country:US
Practice Address - Phone:281-461-1111
Practice Address - Fax:281-461-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty