MEDICARE: OPTUM INFUSION SERVICES 209, INC,

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
4	3336S0011X	Specialty Pharmacy
5	3336H0001X	Home Infusion Therapy Pharmacy

General Provider Information

NPI Number	:	1952490641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM INFUSION SERVICES 209, INC,

Provider Business Mailing Address
First Line	:	1 OPTUM CIR STE 100
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-2956
Country	:	US
Telephone Number	:	800-328-5979
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 FRANKLIN GATEWAY, SUITE 535
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067
Country	:	US
Telephone Number	:	800-925-9749
Fax Number	:	844-243-3370

Authorized Official
Title or Position	:	SECRETARY
Name	:	DENISE MCCABE
Credential	:
Telephone Number	:	952-935-1191

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	05/07/2026

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