Provider Demographics
NPI:1093083289
Name:OPTUM MEDICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:OPTUM MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:M
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-523-5572
Mailing Address - Street 1:150 FAYETTEVILLE ST
Mailing Address - Street 2:BOX1011
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-1395
Mailing Address - Country:US
Mailing Address - Phone:952-917-7217
Mailing Address - Fax:
Practice Address - Street 1:150 FAYETTEVILLE ST
Practice Address - Street 2:BOX 1011
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1395
Practice Address - Country:US
Practice Address - Phone:952-917-7217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization