Provider Demographics
NPI:1467606087
Name:OPTIMUS HEALTH CARE INC.
Entity Type:Organization
Organization Name:OPTIMUS HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LUDWIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-696-3260
Mailing Address - Street 1:982 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06608-1913
Mailing Address - Country:US
Mailing Address - Phone:203-696-3260
Mailing Address - Fax:203-332-0376
Practice Address - Street 1:1351 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2419
Practice Address - Country:US
Practice Address - Phone:203-621-3700
Practice Address - Fax:203-621-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0448261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004234788Medicaid
CTC00383OtherMEDICARE PART B
CT071837Medicare Oscar/Certification