Healthcare Provider Details

I. General information

NPI: 1841673811
Provider Name (Legal Business Name): OPTUM INFUSION SERVICES 100, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 POST RD STE. 5
ALBANY NY
12205-4781
US

IV. Provider business mailing address

15529 COLLEGE BLVD
LENEXA KS
66219-1351
US

V. Phone/Fax

Practice location:
  • Phone: 518-218-1772
  • Fax: 518-218-1093
Mailing address:
  • Phone: 844-902-9352
  • Fax: 877-542-9352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number033657
License Number StateNY

VIII. Authorized Official

Name: EDWARD KRAMM
Title or Position: PRESIDENT
Credential:
Phone: 877-342-9352