NPIMap

Organization Active NPI

Optumcare Florida, LLC

  • Non-Pharmacy Dispensing Site
  • Tampa, FL
National Provider Identifier
1043687072
Registry record updated Aug 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
ME81584 Issued in FL
Legal business name
OPTUMCARE FLORIDA, LLC
Practice address
2727 W Dr MLK Blvd
Suite 850
Tampa, FL 33607-6383
Phone
(813) 871-2717
NPI assigned
Aug 25, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John G. Liethen
Title
Secretary
Phone
(952) 205-6262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X ME81584 FL Primary

Addresses

Primary practice location

2727 W Dr MLK Blvd
Suite 850
Tampa, FL 33607-6383

Mailing address

10051 5TH Street N.
Suite 200
St. Petersburg, FL 33702

Other names 1

  • DaVita Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Davita Medical Group13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10051 5th St N
Ste 200
St Petersburg, FL 33702
Phone (727) 286-4093

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566259200000",
    "number": "1043687072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10051 5TH STREET N.",
            "address_2": "SUITE 200",
            "city": "ST. PETERSBURG",
            "state": "FL",
            "postal_code": "33702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 W DR MLK BLVD",
            "address_2": "SUITE 850",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076383",
            "telephone_number": "813-871-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE FLORIDA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-25",
        "last_updated": "2019-08-20",
        "status": "A",
        "authorized_official_last_name": "LIETHEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "952-205-6262"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "ME81584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DaVita Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.