Provider Demographics
NPI:1295821395
Name:OPTIMUM HEALTH MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:OPTIMUM HEALTH MANAGEMENT CORPORATION
Other - Org Name:OPTIMUM MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HESLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-236-9595
Mailing Address - Street 1:575 W PIKE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7685
Mailing Address - Country:US
Mailing Address - Phone:770-236-9595
Mailing Address - Fax:770-236-9592
Practice Address - Street 1:575 W PIKE ST STE 2
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7685
Practice Address - Country:US
Practice Address - Phone:770-236-9595
Practice Address - Fax:770-236-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000934843AMedicaid
GA000934843AMedicaid