Provider Demographics
NPI:1073561825
Name:OPTUM WOMEN'S AND CHILDREN'S HEALTH, LLC
Entity Type:Organization
Organization Name:OPTUM WOMEN'S AND CHILDREN'S HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-767-4500
Mailing Address - Street 1:2100 RIVEREDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4693
Mailing Address - Country:US
Mailing Address - Phone:770-767-4500
Mailing Address - Fax:678-355-4092
Practice Address - Street 1:2100 RIVEREDGE PKWY
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4693
Practice Address - Country:US
Practice Address - Phone:770-767-4500
Practice Address - Fax:678-355-4092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY WELLNESS SOLUTIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-04
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251F00000X, 332B00000X, 251E00000X, 251F00000X, 332B00000X
NY9937L002251E00000X
OH22700251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00924448AMedicaid
559209OtherAETNA
GA00924448AMedicaid
OH=========300OtherMEDICAL MUTUAL OF OH ANTH
=========OtherUNITED HEALTHCARE
SC=========011OtherBCBS OF SC
=========OtherCIGNA