Provider Demographics
NPI:1790009256
Name:OPTUM INFUSION SERVICES 205, INC
Entity Type:Organization
Organization Name:OPTUM INFUSION SERVICES 205, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE ANALYST
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 1:15529 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1351
Mailing Address - Country:US
Mailing Address - Phone:877-342-9352
Mailing Address - Fax:877-542-9352
Practice Address - Street 1:1812 RIGGINS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7833
Practice Address - Country:US
Practice Address - Phone:954-796-3338
Practice Address - Fax:954-796-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299993694OtherHOME HEALTH AGENCY LICENSE