MEDICARE: OPTION 1 NUTRITION SOLUTIONS LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891094108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTION 1 NUTRITION SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	400 INTERSTATE NORTH PKWY SE
Second Line	:	SUITE 1600
City	:	ATLANTA
State	:	GA
Zip	:	30339-5047
Country	:	US
Telephone Number	:	470-464-8000
Fax Number	:	770-248-8192

Provider Business Practice Location Address
First Line	:	4149 HIGHLINE BLVD STE 275
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73108-2072
Country	:	US
Telephone Number	:	866-883-1188
Fax Number	:	833-896-7003

Authorized Official
Title or Position	:	CFO
Name	:	MATTHEW BUCKHALTER
Credential	:
Telephone Number	:	470-464-8000

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	01/27/2025

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