Provider Demographics
NPI:1619258480
Name:OPTUM INFUSION SERVICES 203, INC.
Entity Type:Organization
Organization Name:OPTUM INFUSION SERVICES 203, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE ANALYST / PARALEGAL
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-335-6786
Mailing Address - Street 1:7850 NW 146TH ST STE 513
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1516
Mailing Address - Country:US
Mailing Address - Phone:786-972-3210
Mailing Address - Fax:855-407-1229
Practice Address - Street 1:7850 NW 146TH ST STE 513
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1516
Practice Address - Country:US
Practice Address - Phone:786-972-3210
Practice Address - Fax:855-407-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299993920OtherHOME HEALTH AGENCY