MEDICARE: OPTIMUM PHYSICIANS HEALTHCARE 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1851987077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM PHYSICIANS HEALTHCARE PLLC

Provider Business Mailing Address
First Line	:	1819 BROADWAY ST STE 101
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-5671
Country	:	US
Telephone Number	:	281-993-4109
Fax Number	:	877-781-5179

Provider Business Practice Location Address
First Line	:	2825 NASA PKWY
Second Line	:
City	:	SEABROOK
State	:	TX
Zip	:	77586-3215
Country	:	US
Telephone Number	:	281-532-3421
Fax Number	:	877-781-6179

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN ERIC MCINTYRE
Credential	:
Telephone Number	:	281-993-4109

Provider Enumeration Date	:	12/13/2020
Last Update Date	:	12/13/2020

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