Provider Demographics
NPI:1346593118
Name:OPTUM INFUSION SERVICES 550, LLC
Entity Type:Organization
Organization Name:OPTUM INFUSION SERVICES 550, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BURR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-310-4701
Mailing Address - Street 1:11000 OPTUM CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-2503
Mailing Address - Country:US
Mailing Address - Phone:800-328-5979
Mailing Address - Fax:
Practice Address - Street 1:1819 ASTON AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7338
Practice Address - Country:US
Practice Address - Phone:760-707-1486
Practice Address - Fax:760-931-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1346593118Medicaid
MN1346593118Medicaid
NM86681818Medicaid
AZ1346593118Medicaid
CA1346593118Medicaid
2137795OtherPK
CA1346593118Medicaid
5351540005Medicare NSC
CA1346593118Medicaid
5351540005Medicare NSC