Provider Demographics
NPI:1972907897
Name:OPTIMUM PHYSICIANS HEALTHCARE PLLC
Entity Type:Organization
Organization Name:OPTIMUM PHYSICIANS HEALTHCARE PLLC
Other - Org Name:OPTIMUM PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-993-4109
Mailing Address - Street 1:1819 BROADWAY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5671
Mailing Address - Country:US
Mailing Address - Phone:281-993-2003
Mailing Address - Fax:281-993-0634
Practice Address - Street 1:1819 BROADWAY ST STE 101
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5671
Practice Address - Country:US
Practice Address - Phone:281-993-2003
Practice Address - Fax:281-993-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3155207L00000X, 208VP0000X
261QP2300X
TXPA07605363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX387952Medicare PIN