MEDICARE: OPTUM MEDICAL SERVICES PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1780090381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM MEDICAL SERVICES PC

Provider Business Mailing Address
First Line	:	PO BOX 692
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55440-0692
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5060 S FORT APACHE RD
Second Line	:	SUITE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1716
Country	:	US
Telephone Number	:	877-456-5506
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	DR. RONALD SHUMACHER
Credential	:	MD
Telephone Number	:	952-205-1189

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	07/03/2014

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