Healthcare Provider Details

I. General information

NPI: 1154318103
Provider Name (Legal Business Name): OPTUM CARE WASHINGTON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3927 RUCKER AVE SUITE101
EVERETT WA
98201-4833
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 425-317-3950
  • Fax:
Mailing address:
  • Phone: 425-317-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GEORGE GO
Title or Position: BOARD PRESIDENT
Credential: MD
Phone: 425-259-0966