Provider Demographics
NPI:1184755738
Name:OPTIMUM HEALTH INSTITUTE
Entity type:Organization
Organization Name:OPTIMUM HEALTH INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-366-7447
Mailing Address - Street 1:6501 DOGWOOD VIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7857
Mailing Address - Country:US
Mailing Address - Phone:601-366-7447
Mailing Address - Fax:601-366-7427
Practice Address - Street 1:6501 DOGWOOD VIEW PKWY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7857
Practice Address - Country:US
Practice Address - Phone:601-366-7447
Practice Address - Fax:601-366-7427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05638837Medicaid
MS05638837Medicaid