MEDICARE: OPTUM PALLIATIVE AND HOSPICE CARE OF TEXAS, INC.

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	251G00000X	Community Based Hospice Care Agency
2	251G00000X	Community Based Hospice Care Agency	012312	TX

General Provider Information

NPI Number	:	1104048685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM PALLIATIVE AND HOSPICE CARE OF TEXAS, INC.

Provider Business Mailing Address
First Line	:	1009 WINDCROSS CT
Second Line	:	SUITE 101
City	:	FRANKLIN
State	:	TN
Zip	:	37067
Country	:	US
Telephone Number	:	615-224-5440
Fax Number	:

Provider Business Practice Location Address
First Line	:	5835 CALLAGHAN RD
Second Line	:	SUITE 400
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1125
Country	:	US
Telephone Number	:	210-684-3900
Fax Number	:	210-684-3905

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN ENDERLE
Credential	:
Telephone Number	:	860-616-7221

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	12/07/2015

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