Provider Demographics
NPI: | 1013442029 |
---|---|
Name: | OPTUM MEDICAL CARE, P.C. |
Entity Type: | Organization |
Organization Name: | OPTUM MEDICAL CARE, P.C. |
Other - Org Name: | CAREMOUNT MEDICAL, P.C. |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SCOTT |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | HAYWORTH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 914-302-8392 |
Mailing Address - Street 1: | 110 S. BEDFORD ROAD |
Mailing Address - Street 2: | |
Mailing Address - City: | MOUNT KISCO |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10549 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 914-242-5621 |
Mailing Address - Fax: | 914-242-1516 |
Practice Address - Street 1: | 2 INTERNATIONAL BLVD |
Practice Address - Street 2: | |
Practice Address - City: | BREWSTER |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10509 |
Practice Address - Country: | US |
Practice Address - Phone: | 914-241-1050 |
Practice Address - Fax: | 914-242-1516 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | OPTUM MEDICAL CARE, P.C. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2017-04-27 |
Last Update Date: | 2022-10-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
Yes | 291U00000X | Laboratories | Clinical Medical Laboratory | Group - Multi-Specialty | |
No | 176B00000X | Other Service Providers | Midwife | Group - Multi-Specialty | |
No | 207KA0200X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | Group - Multi-Specialty |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207ND0101X | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | Group - Multi-Specialty |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | Group - Multi-Specialty |