Provider Demographics
NPI:1881262905
Name:A B O ON THE GO LLC
Entity type:Organization
Organization Name:A B O ON THE GO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KELSI
Authorized Official - Middle Name:JANEE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:281-628-4000
Mailing Address - Street 1:9219 KENDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-8011
Mailing Address - Country:US
Mailing Address - Phone:281-628-4000
Mailing Address - Fax:
Practice Address - Street 1:9219 KENDALE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-8011
Practice Address - Country:US
Practice Address - Phone:281-628-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service