Organization
MODERN MEDICAL, INC.
Active
Other names
Optum Workers Compensation Medical Services
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WILLIAM BENCIVENGA (GENERAL COUNSEL)
(813) 318-6831
Entity
Organization
Contact information
Practice address
250 PROGRESSIVE WAY, SUITE 100, WESTERVILLE, OH 43082-9615
(800) 547-3330
(614) 212-8008
Mailing address
250 PROGRESSIVE WAY, SUITE 100, WESTERVILLE, OH 43082-9615
(800) 547-3330
(614) 212-8008
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
HMER 23503
OH
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332S00000X
Hearing Aid Equipment
—
—
333600000X
Pharmacy
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
347E00000X
Transportation Broker
—
—
Other
Enumeration date
08/04/2005
Last updated
03/13/2017
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