Provider Demographics
NPI:1841673811
Name:OPTUM INFUSION SERVICES 100, INC.
Entity type:Organization
Organization Name:OPTUM INFUSION SERVICES 100, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-342-9352
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:844-902-9352
Mailing Address - Fax:877-542-9352
Practice Address - Street 1:25 POST RD
Practice Address - Street 2:STE. 5
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4781
Practice Address - Country:US
Practice Address - Phone:518-218-1772
Practice Address - Fax:518-218-1093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTUM INFUSION SERVICES 100, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-08
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X
NY0336573336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7422240001Medicaid
NY7422240001Medicaid