Organization
OPTUMCARE FLORIDA, LLC
Active
Organization
OPTUMCARE FLORIDA, LLC
Active
Other names
DaVita Medical Group, JSA Medical Group- West Colonial
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN G. LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization
Contact information
Practice address
7240 W COLONIAL DR, ORLANDO, FL 32818-6749
(407) 296-2273
Mailing address
10051 5TH STREET N., ST. PETERSBURG, FL 33702
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
ME74038
FL
Other
Enumeration date
08/25/2015
Last updated
08/20/2019
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