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OPTUM INFUSION SERVICES 204 INC. NPI 1588936785


NPI Information

NPI: 1588936785
Provider Name: OPTUM INFUSION SERVICES 204, INC.
Classification: Pharmacy - 3336H0001X
Entity Type: Organization

Specialization: Home Infusion Therapy Pharmacy

Address:
4220 EXECUTIVE CIRCLE, SUITE 62
FORT MYERS, FL
ZIP 33916
Phone: (239) 561-2388
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OPTUM INFUSION SERVICES 204, INC. is a home infusion therapy pharmacy pharmacy in Fort Myers, FL. The provider is pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. Extensive professional pharmacy services, care coordination, infusion nursing services, supplies and equipment are provided to optimize efficacy and compliance. OPTUM INFUSION SERVICES 204, INC. NPI is 1588936785. The provider is registered as an organization entity type.

The provider's business location address is:

4220 EXECUTIVE CIRCLE, SUITE 62
FORT MYERS, FL
ZIP 33916
Phone: (239) 561-2388
Fax: (844) 830-1983

The provider's authorized official is David John Oberg .
The authorized official title is Assistant Secretary and has the following contact phone number (949) 988-5893.

The enumeration date for this NPI number is 2/2/2012 and was last updated on 12/29/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251E00000XHome HealthNo
23336C0004XPharmacyCompounding PharmacyPH 27821FLORIDANo
33336H0001XPharmacyHome Infusion Therapy PharmacyPH26240FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1015940200MEDICAIDFLORIDA
2015940201MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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