Provider Demographics
NPI:1902157449
Name:OPTIMUM EMERGENCY CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:OPTIMUM EMERGENCY CARE ASSOCIATES LLC
Other - Org Name:OPTIMUM ER
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-728-3431
Mailing Address - Street 1:1 WIND POPPY CT
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2823
Mailing Address - Country:US
Mailing Address - Phone:281-728-3431
Mailing Address - Fax:
Practice Address - Street 1:4524 RESEARCH FOREST DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-4237
Practice Address - Country:US
Practice Address - Phone:281-728-3431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care