MEDICARE: OPTUM INFUSION SERVICES 501 INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	3336C0004X	Compounding Pharmacy
3	3336H0001X	Home Infusion Therapy Pharmacy

General Provider Information

NPI Number	:	1730855701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM INFUSION SERVICES 501 INC

Provider Business Mailing Address
First Line	:	1 OPTUM CIR STE 100
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-2503
Country	:	US
Telephone Number	:	800-328-5979
Fax Number	:

Provider Business Practice Location Address
First Line	:	1867 LACKLAND HILL PKWY
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3545
Country	:	US
Telephone Number	:	800-560-8424
Fax Number	:	877-542-9352

Authorized Official
Title or Position	:	SECRETARY
Name	:	KEVIN EUGENE BURR
Credential	:
Telephone Number	:	712-310-4701

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	12/04/2024

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