Provider Demographics
NPI:1033489562
Name:OPTIMED HEALTH PARTNERS INC
Entity Type:Organization
Organization Name:OPTIMED HEALTH PARTNERS INC
Other - Org Name:OPTIMED SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-250-8018
Mailing Address - Street 1:6480 TECHNOLOGY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8116
Mailing Address - Country:US
Mailing Address - Phone:877-385-0535
Mailing Address - Fax:877-326-2856
Practice Address - Street 1:6480 TECHNOLOGY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8116
Practice Address - Country:US
Practice Address - Phone:877-385-0535
Practice Address - Fax:877-326-2856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHNR0002913336S0011X
HIPMP-12783336S0011X
KS22-450663336S0011X
KYMI19143336S0011X
IN64001694A3336S0011X
COOSP.00064973336S0011X
AK1101823336S0011X
LAPHY.007111-NR3336S0011X
IA45663336S0011X
IL54.0188363336S0011X
DEA9-00018483336S0011X
ID40838MS3336S0011X
FLPH285903336S0011X
DCNRX00009913336S0011X
CTPCN.00031013336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133173OtherPK