Organization
OPTUMCARE FLORIDA, LLC
Active
Other names
DaVita Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN G. LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization
Contact information
Practice address
1345 W BAY DR, SUITE 202, LARGO, FL 33770-2282
(727) 559-0895
Mailing address
10051 5TH STREET N., ST. PETERSBURG, FL 33702
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
ME86502
FL
Other
Enumeration date
03/26/2015
Last updated
08/19/2019
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