MEDICARE: JACOB EGLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1912854415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB EGLY

Provider Business Mailing Address
First Line	:	448 W 19TH ST # 103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3914
Country	:	US
Telephone Number	:	713-818-5908
Fax Number	:

Provider Business Practice Location Address
First Line	:	448 W 19TH ST # 103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3914
Country	:	US
Telephone Number	:	713-818-5908
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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Directions to “ JACOB EGLY ” Practice Location

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