Provider Demographics
NPI:1508047705
Name:JO POLLACK, MD, PA
Entity Type:Organization
Organization Name:JO POLLACK, MD, PA
Other - Org Name:JP SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:M
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-461-1013
Mailing Address - Street 1:18300 KATY FWY STE 275
Mailing Address - Street 2:MEDICAL OFFICE BUILDING 2
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1521
Mailing Address - Country:US
Mailing Address - Phone:713-496-1101
Mailing Address - Fax:713-461-1593
Practice Address - Street 1:18300 KATY FWY STE 275
Practice Address - Street 2:MEDICAL OFFICE BUILDING 2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1521
Practice Address - Country:US
Practice Address - Phone:713-496-1101
Practice Address - Fax:713-461-1593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6665208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00140339OtherMEDICARE RAILROAD
TX1711335-01Medicaid
00678WMedicare PIN
TXP00140339OtherMEDICARE RAILROAD