Provider Demographics
NPI:1760189013
Name:MD JANUARY PLLC
Entity Type:Organization
Organization Name:MD JANUARY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EBONI
Authorized Official - Middle Name:
Authorized Official - Last Name:JANUARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-268-4830
Mailing Address - Street 1:10918 BRAMBLING WOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2320
Mailing Address - Country:US
Mailing Address - Phone:573-268-4830
Mailing Address - Fax:
Practice Address - Street 1:9894 BISSONNET ST STE 470
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8282
Practice Address - Country:US
Practice Address - Phone:833-635-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No291U00000XLaboratoriesClinical Medical Laboratory