Healthcare Provider Details

I. General information

NPI: 1942351564
Provider Name (Legal Business Name): OPTUMHEALTH CARE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 HIGHWAY 55 MN010-W120
GOLDEN VALLEY MN
55427-4946
US

IV. Provider business mailing address

PO BOX 212
MINNEAPOLIS MN
55440-0212
US

V. Phone/Fax

Practice location:
  • Phone: 763-595-3200
  • Fax: 763-595-3333
Mailing address:
  • Phone: 763-595-3200
  • Fax: 763-595-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHN DESMET
Title or Position: COO
Credential:
Phone: 763-797-4821