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General NPI Number Information
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NPI Number | 1710393392
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Entity Type | Organization
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Legal Business Name | OPTUM CLINIC PA
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Dates
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Enumeration Date | 07/03/2014
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 69 S VALLE VERDE DR.
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City | HENDERSON
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State | NV
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Zip | 89012
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Country | US
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Telephone | 877-456-5506
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 692
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City | MINNEAPOLIS
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State | MN
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Zip | 55440-0692
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Country | US
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Telephone | 877-456-5506
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. CURTIS MOCK
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Credential | MD
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Telephone | 401-732-7325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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