Salud Optima Direct, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

428872 Issued in PA

Legal business name

SALUD OPTIMA DIRECT, PLLC

Practice address

152 Garrett Rd
Upper Darby, PA 19082-3113

Phone

(484) 401-9012

Fax

(484) 401-9012

NPI assigned

Jul 14, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Marcus Rey Williams, MD

Title

Chief Medical Officer

Phone

(610) 425-1165

Specialties & licenses 1

Addresses

Other names 1

• Optimal Health Direct Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405296000000",
    "number": "1588071492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 GARRETT RD",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190823113",
            "telephone_number": "484-401-9012",
            "fax_number": "484-401-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 GARRETT RD",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190823113",
            "telephone_number": "484-401-9012",
            "fax_number": "484-401-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALUD OPTIMA DIRECT, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-14",
        "last_updated": "2014-07-14",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_middle_name": "REY",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "610-425-1165",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "PA",
            "license": "428872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optimal Health Direct",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Primary Care Clinic/Center in Upper Darby, PA
• Providers in Upper Darby, PA by specialty
• Primary Care Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.