1174286728 NPI number — OPTUM INFUSION SERVICES 550, LLC

Table of content: (NPI 1174286728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174286728 NPI number — OPTUM INFUSION SERVICES 550, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTUM INFUSION SERVICES 550, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174286728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 OPTUM CIR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-328-5979
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 COMMERCE WAY STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-1057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-427-4862
Provider Business Practice Location Address Fax Number:
877-342-4596
Provider Enumeration Date:
10/20/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BURR
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
712-310-4701

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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