Provider Demographics
NPI:1558785253
Name:OPTUMUMHEALTHOUTCOMES
Entity Type:Organization
Organization Name:OPTUMUMHEALTHOUTCOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-394-7181
Mailing Address - Street 1:4531 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-7805
Mailing Address - Country:US
Mailing Address - Phone:407-394-7181
Mailing Address - Fax:810-222-6666
Practice Address - Street 1:5104 N ORANGE BLOSSOM TRL
Practice Address - Street 2:SUITE 108
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-1042
Practice Address - Country:US
Practice Address - Phone:407-394-7181
Practice Address - Fax:810-222-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-16
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109752000Medicaid