Provider Demographics
NPI:1447566443
Name:OPTIMUS MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:OPTIMUS MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:412-215-9642
Mailing Address - Street 1:3402 BATTLEGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2404
Mailing Address - Country:US
Mailing Address - Phone:336-545-1515
Mailing Address - Fax:336-545-4505
Practice Address - Street 1:3402 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2404
Practice Address - Country:US
Practice Address - Phone:336-545-1515
Practice Address - Fax:336-545-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00296261QU0200X
NC200000836207Q00000X, 207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1447566443OtherNPI
NC1447566443OtherNPI