Organization
OPTUMCARE FLORIDA, LLC
Active
Other names
JSA Healthcare Corporation
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN G. LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization
Contact information
Practice address
4757 US HIGHWAY 19, NEW PORT RICHEY, FL 34652-4945
(727) 849-9373
(727) 841-0497
Mailing address
10051 5TH STREET NORTH, ST. PETERSBURG, FL 33702-2299
(727) 849-9373
(727) 841-0497
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH18603
FL
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030843900
—
FL
01
—
2014572
PK
—
05
—
4399230001
—
FL
Enumeration date
12/11/2006
Last updated
08/19/2019
Update your record
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