Healthcare Provider Details

I. General information

NPI: 1184166183
Provider Name (Legal Business Name): OPTUM PALLIATIVE AND HOSPICE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S VALLE VERDE DR SUITE 100
HENDERSON NV
89012-3462
US

IV. Provider business mailing address

1009 WINDCROSS CT SUITE 101
FRANKLIN TN
37067-2678
US

V. Phone/Fax

Practice location:
  • Phone: 952-205-1263
  • Fax: 844-727-9218
Mailing address:
  • Phone: 615-224-5443
  • Fax: 844-727-9218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085H0002X
TaxonomyHospice and Palliative Medicine (Radiology) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN O. ENDERLE
Title or Position: SR. VP/CFO
Credential:
Phone: 860-221-0793