OPTUM INFUSION SERVICES 302, LLC (NPI# 1245564012) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1245564012 |
Entity Type | Organization |
Organization Name | OPTUM INFUSION SERVICES 302, LLC |
Practice Address |
8720 South 114th Street, Suite 106 La Vista NE 68128 |
Practice Telephone | 8552953154 |
Practice Fax Number | 8442048056 |
Mailing Telephone | 8552953154 |
Mailing Fax Number | 8442048056 |
Enumeration Date | 2009-09-28 |
Last Update Date | 2019-10-08 |
Authorized Official Name | EDWARD KRAMM (CEO) |
Authorized Official Telephone | 8773429352 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers | ||
N | 3336S0011X |
Pharmacy Specialization: Specialty Pharmacy |
Suppliers | ||
Y | 3336H0001X |
Pharmacy Specialization: Home Infusion Therapy Pharmacy |
3095 | NE | Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NE | 10025826900 | 05 | |
NCPDP PROVIDER IDENTIFICATION NUMBER | 2817863 | 01 |
Other Name | Type Code |
---|---|
AxelaCare | Doing Business As Name - Organization |
Street Address |
8720 SOUTH 114TH STREET, SUITE 106 |
City | LA VISTA |
State | NE |
Zip Code | 68128 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1922589746 | Ruth Ann Moses | Prevention Professional | 7030 S 110th St, Omaha, NE 68128 | 2018-08-29 |
1972945897 | Jenna Leigh Graeve | Physical Therapist | 7040 S 114th St Plz Apt 203, La Vista, NE 68128 | 2013-07-19 |
1730385709 | Granville Assisted Living, LLC | Point of Service | 5807 Granville Parkway, La Vista, NE 68128 | 2007-06-26 |
1629160072 | Rachel L. Mccann | Pediatrics | 9801 Giles Road, Suite 1, La Vista, NE 68128 | 2006-09-29 |
1730118233 | Donald R Krysl | Optometrist | 8102 S 84th St, Lavista, NE 68128 | 2006-06-30 |
1073030607 | September Leigh Wanzenried | Family Medicine | 6901 S 84th St, La Vista, NE 68128 | 2017-08-24 |
1518312719 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 12515 Portside Pkwy, La Vista, NE 68128 | 2016-04-26 |
1245685445 | Costco Wholesale Corporation | Hearing Aid Equipment | 12515 Portside Pkwy, La Vista, NE 68128 | 2016-04-26 |
1386011971 | Kelsey Klatt | Occupational Therapist | 6960 S 110th St, La Vista, NE 68128 | 2015-08-31 |
1003299827 | Jordan Tichenor | Internal Medicine | 8604 Giles Rd, La Vista, NE 68128 | 2015-06-30 |
Find all providers in zip 68128 |
Taxonomy Code | 3336H0001X |
Grouping | Suppliers |
Classification | Pharmacy |
Specialization | Home Infusion Therapy Pharmacy |
Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. Extensive professional pharmacy services, care coordination, infusion nursing services, supplies and equipment are provided to optimize efficacy and compliance. |
Notes: Source: National Home Infusion Association [1/1/2006: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1063956571 | Greater Nebraska Home Infusion Inc | Pharmacy | 2604 Saint Patrick Ave Ste 2, Grand Island, NE 68803-1313 | 2016-12-19 |
1922043603 | Good Samaritan Hospital | Pharmacy | 2501 30th Ave, Kearney, NE 68845-4017 | 2006-06-18 |
1043642473 | Chi National Home Care | Pharmacy | 5428 F St, Omaha, NE 68117-2815 | 2013-08-08 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.