Provider Demographics
NPI:1942391271
Name:OPTUM INFUSION SERVICES 201, INC.
Entity type:Organization
Organization Name:OPTUM INFUSION SERVICES 201, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BURR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-310-4701
Mailing Address - Street 1:5700 DOT COM, SUITE 1050
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765
Mailing Address - Country:US
Mailing Address - Phone:888-999-8586
Mailing Address - Fax:844-830-2088
Practice Address - Street 1:5700 DOT COM, SUITE 1050
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765
Practice Address - Country:US
Practice Address - Phone:888-999-8586
Practice Address - Fax:844-830-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2024-08-08
Deactivation Date:2023-06-22
Deactivation Code:
Reactivation Date:2024-08-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251E00000XAgenciesHome Health
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH18928OtherPHARMACY
FL016048401Medicaid
FL016048400Medicaid
FL299991682OtherHOME HEALTH NURSING
FLPH18928OtherPHARMACY
FL4676850001Medicare NSC