OPTUM INFUSION SERVICES 550, LLC

Provider Demographics

• NPI: 1851337778
• Name: OPTUM INFUSION SERVICES 550, LLC
• Entity Type: Organization
• Organization Name: OPTUM INFUSION SERVICES 550, LLC
• Authorized Official - Title/Position: SECRETARY
• Authorized Official - First Name: KEVIN
• Authorized Official - Middle Name: EUGENE
• Authorized Official - Last Name: BURR
• Authorized Official - Phone: 712-310-4701
• Mailing Address - Street 1: 11000 OPTUM CIR STE 100
• Mailing Address - City: EDEN PRAIRIE
• Mailing Address - State: MN
• Mailing Address - Zip Code: 55344-2503
• Mailing Address - Country: US
• Mailing Address - Phone: 800-328-5979
• Practice Address - Street 1: 7167 E KEMPER RD
• Practice Address - City: CINCINNATI
• Practice Address - State: OH
• Practice Address - Zip Code: 45249-1028
• Practice Address - Country: US
• Practice Address - Phone: 513-792-7080
• Practice Address - Fax: 513-792-3838
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-06-20
• Last Update Date: 2024-02-09

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336H0001X	Suppliers	Pharmacy	Home Infusion Therapy Pharmacy
No	251F00000X	Agencies	Home Infusion
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	332BP3500X	Suppliers	Durable Medical Equipment & Medical Supplies	Parenteral & Enteral Nutrition
No	333600000X	Suppliers	Pharmacy
No	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy
No	3336C0004X	Suppliers	Pharmacy	Compounding Pharmacy
No	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
PA	102080003003	Medicaid
IA	1851337778	Medicaid
MN	1851337778	Medicaid
IN	200497810A	Medicaid
OH	2513846	Medicaid
AK	PH002OH	Medicaid
OK	200051160A	Medicaid
MD	510469600	Medicaid
KY	7100150340	Medicaid
KY	7100162850	Medicaid
MD	510468800	Medicaid
CO	93773765	Medicaid
ME	1851337778	Medicaid
AZ	309255	Medicaid
TN	4582576	Medicaid
NE	1002156200	Medicaid
VA	1851337778	Medicaid
MI	3672715	Medicaid
	2079744	Other	PK
ID	1851337778	Medicaid
WA	6028575	Medicaid
SC	7H5300	Medicaid
CO	93773765	Medicaid
WA	6028575	Medicaid
CO	93773765	Medicaid
IA	1851337778	Medicaid
CO	93773765	Medicaid