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General NPI Number Information
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NPI Number | 1528676335
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Entity Type | Organization
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Legal Business Name | OPTIMUSORTHO BUNDLE MANAGEMENT, LLC
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 3801 WAKE FOREST RD STE 220
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City | RALEIGH
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State | NC
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Zip | 27609-6864
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Country | US
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Telephone | 919-872-5296
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31993
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City | RALEIGH
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State | NC
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Zip | 27622-1993
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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 | PRESIDENT/ MEMBER
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Name | PAUL BURROUGHS III
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Credential | MD
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Telephone | 919-673-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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