MEDICARE: OPTUMCARE MANAGEMENT, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies	1312625	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1312625	OTHER	FL	HME LICENSE

General Provider Information

NPI Number	:	1568461655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUMCARE MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	3150 W PROSPECT RD
Second Line	:	SUITE 320
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-2597
Country	:	US
Telephone Number	:	954-677-1011
Fax Number	:	954-677-0922

Provider Business Practice Location Address
First Line	:	3150 W PROSPECT RD
Second Line	:	SUITE 320
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-2597
Country	:	US
Telephone Number	:	954-677-1011
Fax Number	:	954-677-0922

Authorized Official
Title or Position	:	SECRETARY
Name	:	JOHN G. LIETHEN
Credential	:
Telephone Number	:	952-205-6262

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/20/2019

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