Healthcare Provider Details

I. General information

NPI: 1508465865
Provider Name (Legal Business Name): OPTIMED HEALTH PARTNERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 LUCERNE TER
ORLANDO FL
32806-1016
US

IV. Provider business mailing address

6480 TECHNOLOGY AVE STE A
KALAMAZOO MI
49009-8126
US

V. Phone/Fax

Practice location:
  • Phone: 269-250-8000
  • Fax:
Mailing address:
  • Phone: 269-250-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TED RAFFERTY
Title or Position: HR MANAGER
Credential:
Phone: 269-250-8000