Healthcare Provider Details

I. General information

NPI: 1366747800
Provider Name (Legal Business Name): OPTION 1 NUTRITION SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 SE 2ND ST
GALVA IL
61434-1531
US

IV. Provider business mailing address

400 INTERSTATE NORTH PKWY SE SUITE 1600
ATLANTA GA
30339-5047
US

V. Phone/Fax

Practice location:
  • Phone: 309-932-3000
  • Fax: 309-932-3033
Mailing address:
  • Phone: 470-464-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203001287
License Number StateIL

VIII. Authorized Official

Name: MATTHEW BUCKHALTER
Title or Position: CFO
Credential:
Phone: 470-464-8000