Provider Demographics
NPI:1639566250
Name:TEXAS OPTIMUM HEALTHCARE, LLC
Entity Type:Organization
Organization Name:TEXAS OPTIMUM HEALTHCARE, LLC
Other - Org Name:NORTH TEXAS OPTIMUM HEALTHCARE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-387-3837
Mailing Address - Street 1:2210 SAN JACINTO BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7531
Mailing Address - Country:US
Mailing Address - Phone:940-387-3837
Mailing Address - Fax:940-387-9924
Practice Address - Street 1:2210 SAN JACINTO BLVD
Practice Address - Street 2:STE. 4
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7531
Practice Address - Country:US
Practice Address - Phone:940-387-3837
Practice Address - Fax:940-387-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2408207Q00000X
TXP1368207Q00000X
TXPA08941363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016338-0025OtherUNITED HEALTHCARE
TX132492OtherAETNA
TXH00022BA010001OtherBLUE CROSS BLUE SHIELD
TX0022BAOtherBLUE CROSS BLUE SHIELD
TXH00022BA010001OtherBLUE CROSS BLUE SHIELD