Organization
OPTUMCARE FLORIDA, LLC
Active
Other names
DaVita Medical Group, JSA Medical Group-Seffner
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN G. LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization
Contact information
Practice address
770 W DR MARTIN LUTHER KING JR BLVD, SEFFNER, FL 33584-4534
(813) 654-7005
Mailing address
10051 5TH ST. NORTH, SAINT PETERSBURG, FL 33702
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
OS8544
FL
Other
Enumeration date
03/26/2015
Last updated
08/19/2019
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