Provider Demographics
NPI:1144614009
Name:OPTUMCARE SOUTH FLORIDA, LLC
Entity Type:Organization
Organization Name:OPTUMCARE SOUTH FLORIDA, LLC
Other - Org Name:HEALTHCARE PARTNERS SOUTH FLORIDA LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LIETHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-205-6262
Mailing Address - Street 1:10051 5TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5901 COLONIAL DR
Practice Address - Street 2:SUITE 301
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5675
Practice Address - Country:US
Practice Address - Phone:954-935-1477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48608332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site