MEDICARE: OPTUM MEDICAL GROUP RHODES P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1063458594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM MEDICAL GROUP RHODES P C

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3253
Fax Number	:	702-304-7451

Provider Business Practice Location Address
First Line	:	2010 WELLNESS WAY STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4142
Country	:	US
Telephone Number	:	702-877-0814
Fax Number	:	702-877-3238

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR CREDENTIALING
Name	:	EMILY CASTILLO
Credential	:
Telephone Number	:	702-579-3253

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	10/30/2025

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