Healthcare Provider Details

I. General information

NPI: 1619258480
Provider Name (Legal Business Name): OPTUM INFUSION SERVICES 203, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 NW 146TH ST STE 513
MIAMI LAKES FL
33016-1516
US

IV. Provider business mailing address

7850 NW 146TH ST STE 513
MIAMI LAKES FL
33016-1516
US

V. Phone/Fax

Practice location:
  • Phone: 786-972-3210
  • Fax: 855-407-1229
Mailing address:
  • Phone: 786-972-3210
  • Fax: 855-407-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEY WILLIAMS
Title or Position: COMPLIANCE ANALYST / PARALEGAL
Credential:
Phone: 913-335-6786