MEDICARE: OPTUM CLINIC, P.A.

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1679907919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM CLINIC, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 692
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55440-0692
Country	:	US
Telephone Number	:	877-456-5506
Fax Number	:

Provider Business Practice Location Address
First Line	:	7077 HIGHWAY 6 NORTH
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2505
Country	:	US
Telephone Number	:	281-815-1644
Fax Number	:	866-291-0571

Authorized Official
Title or Position	:	CEO
Name	:	DR. CURTIS MOCK
Credential	:	M.D.
Telephone Number	:	401-732-7325

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	03/14/2016

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