MEDICARE: OPTUM CLINIC, PA

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1912312216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM CLINIC, PA

Provider Business Mailing Address
First Line	:	PO BOX 692
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55440-0692
Country	:	US
Telephone Number	:	877-456-5506
Fax Number	:

Provider Business Practice Location Address
First Line	:	3651 WESLAYAN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-6833
Country	:	US
Telephone Number	:	713-835-3791
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. CURTIS MOCK
Credential	:	MD
Telephone Number	:	401-732-7325

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	03/14/2016

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Directions to “OPTUM CLINIC, PA ” Practice Location

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