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General NPI Number Information
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NPI Number | 1205363777
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Entity Type | Organization
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Legal Business Name | OPTUM INFUSION SERVICES 500, INC.
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 2182 DIVIDEND DRIVE
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City | COLUMBUS
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State | OH
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Zip | 43228
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Country | US
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Telephone | 844-386-2472
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Fax | 888-776-5018
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Provider Business Mailing Address
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Address Line | 1 OPTUM CIR STE 100
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-2503
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Country | US
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Telephone | 800-328-5979
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | KEVIN EUGENE BURR
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Credential |
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Telephone | 712-310-4701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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