=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841832466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTUM INFUSION SERVICES 501 INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2019
-----------------------------------------------------
Last Update Date | 12/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8131 W BOSTIAN RD STE A345
-----------------------------------------------------
City | WOODINVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98072-5029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-234-4120
-----------------------------------------------------
Fax | 866-823-1806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 OPTUM CIR STE 100
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55344-2503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-328-5979
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | MR. KEVIN EUGENE BURR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 712-310-4701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------