MEDICARE: OPTIMUS HEALTH CARE 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	261QF0400X	Federally Qualified Health Center (FQHC)	0234	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	C00383	OTHER	CT	MEDICARE PART B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922378496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUS HEALTH CARE INC

Provider Business Mailing Address
First Line	:	982 E MAIN ST
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06608-1913
Country	:	US
Telephone Number	:	203-696-3260
Fax Number	:	203-332-0376

Provider Business Practice Location Address
First Line	:	727 HONEYSPOT RD
Second Line	:
City	:	STRATFORD
State	:	CT
Zip	:	06615-7172
Country	:	US
Telephone Number	:	203-375-7252
Fax Number	:	203-332-0376

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	LUDWIG SPINELLI
Credential	:
Telephone Number	:	203-696-3260

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	12/30/2011

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Directions to “OPTIMUS HEALTH CARE INC ” Practice Location

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