MEDICARE: OPTIMUM EMERGENCY PHYSICIANS PLLC

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	207P00000X	Emergency Medicine Physician		TX

General Provider Information

NPI Number	:	1366793804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM EMERGENCY PHYSICIANS PLLC

Provider Business Mailing Address
First Line	:	1 WIND POPPY CT
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-2823
Country	:	US
Telephone Number	:	281-728-3431
Fax Number	:

Provider Business Practice Location Address
First Line	:	4524 RESEARCH FOREST DR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-4237
Country	:	US
Telephone Number	:	281-728-3431
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. LARRY TILL
Credential	:	M.D.
Telephone Number	:	281-728-3431

Provider Enumeration Date	:	09/24/2012
Last Update Date	:	09/24/2012

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