Optumcare Florida, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH18512 Issued in FL

Legal business name

OPTUMCARE FLORIDA, LLC

Doing business as

DaVita Medical Group, Pharmacy

Practice address

3665 W Waters Ave
Tampa, FL 33614-2783

Phone

(813) 935-6431

Fax

(813) 915-0741

NPI assigned

Dec 11, 2006

Last updated

Aug 20, 2019By the provider in NPPES

Organization subpart

No

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 2

Addresses

Other identifiers 3

Other names 1

• DaVita Medical Group, Pharmacy Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Intermountain Medical Holdings Nevada Inc

  dba Intermountain Health Home Care

  • Home Health Agency
  • Las Vegas, NV
  • NPI 1689882557

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566259200000",
    "number": "1245390475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10051 5TH ST. N",
            "city": "ST. PETERSBURG",
            "state": "FL",
            "postal_code": "337022289",
            "telephone_number": "727-828-2314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3665 W WATERS AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336142783",
            "telephone_number": "813-935-6431",
            "fax_number": "813-915-0741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE FLORIDA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH18512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "030842100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4399230005",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2014551",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DaVita Medical Group, Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Option Care Enterprises, Inc. (Option Care)
• Option Center, Inc
• Optum Dental Arts PLLC
• Optumcare Florida LLC (Optum)
• Optumcare Florida, LLC (DaVita Medical Group)
• Optumcare Florida, LLC (DaVita Medical Group)
• Optumcare Florida, LLC (Optum)
• Optumcare South Florida, LLC (Optum)
• Nancy Colella Oquendo, RPH
• Mustafa Hasan Oraibi

• Community/Retail Pharmacy in Tampa, FL
• Providers in Tampa, FL by specialty
• Community/Retail Pharmacy in Florida

• 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.