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General NPI Number Information
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NPI Number | 1518770577
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Entity Type | Organization
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Legal Business Name | OPTUM HEART AND VASCULAR, LLC
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 2724 N TENAYA WAY STE 110
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City | LAS VEGAS
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State | NV
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Zip | 89128-0424
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Country | US
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Telephone | 435-565-0704
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Fax |
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Provider Business Mailing Address
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Address Line | 2724 N TENAYA WAY STE 110
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City | LAS VEGAS
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State | NV
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Zip | 89128-0424
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OPERATIONS
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Name | ADAM CHAN
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Credential |
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Telephone | 435-565-0704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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