MEDICARE: OPTUM MEDICAL GROUP RHODES P C

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	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1922733559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM MEDICAL GROUP RHODES P C

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2149
Country	:	US
Telephone Number	:	702-724-8787
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR
Name	:	EMILY CASTILLO
Credential	:
Telephone Number	:	702-480-2550

Provider Enumeration Date	:	07/18/2022
Last Update Date	:	03/02/2026

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