Provider Demographics
NPI:1154104727
Name:IDEAL HEALTH MD, PLLC
Entity type:Organization
Organization Name:IDEAL HEALTH MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:JAGGERS
Authorized Official - Last Name:BRYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-200-4741
Mailing Address - Street 1:6834 CANTRELL RD STE 1117
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-4135
Mailing Address - Country:US
Mailing Address - Phone:501-200-4741
Mailing Address - Fax:
Practice Address - Street 1:417 MAIN ST STE 110N
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-3801
Practice Address - Country:US
Practice Address - Phone:501-200-4741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care