Provider Demographics
NPI:1083771315
Name:OPTUM HEALTHCARE OF ILLINOIS, INC.
Entity Type:Organization
Organization Name:OPTUM HEALTHCARE OF ILLINOIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGGINS-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-767-4824
Mailing Address - Street 1:2100 RIVEREDGE PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4676
Mailing Address - Country:US
Mailing Address - Phone:770-767-4500
Mailing Address - Fax:
Practice Address - Street 1:1600 MCCONNOR PKWY
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-6801
Practice Address - Country:US
Practice Address - Phone:224-231-1070
Practice Address - Fax:678-337-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL582205984007Medicaid
IL582205984007Medicaid