Healthcare Provider Details

I. General information

NPI: 1730855701
Provider Name (Legal Business Name): OPTUM INFUSION SERVICES 501 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 LACKLAND HILL PKWY
SAINT LOUIS MO
63146-3545
US

IV. Provider business mailing address

1 OPTUM CIR STE 100
EDEN PRAIRIE MN
55344-2503
US

V. Phone/Fax

Practice location:
  • Phone: 800-560-8424
  • Fax: 877-542-9352
Mailing address:
  • Phone: 800-328-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEVIN EUGENE BURR
Title or Position: SECRETARY
Credential:
Phone: 712-310-4701