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
7601 9TH ST N, STE C 1, ST PETERSBURG, FL 33702-5211
(727) 520-7995
(727) 520-7963
Mailing address
10051 5TH STREET N., ST PETERSBURG, FL 33702
(727) 520-7995
(727) 520-7963
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH19244
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030938900
—
FL
01
—
2015674
PK
—
Enumeration date
12/11/2006
Last updated
08/19/2019
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