Provider Demographics
NPI:1407670425
Name:OPTIMAL RESEARCH SITES, LLC
Entity type:Organization
Organization Name:OPTIMAL RESEARCH SITES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MRS.
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL CAMPPO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:386-218-5911
Mailing Address - Street 1:2541 S VOLUSIA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-9116
Mailing Address - Country:US
Mailing Address - Phone:386-218-5911
Mailing Address - Fax:386-406-8365
Practice Address - Street 1:2541 S VOLUSIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-9116
Practice Address - Country:US
Practice Address - Phone:386-218-5911
Practice Address - Fax:386-406-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1053092221Medicaid
FL1285686824Medicaid
FL1881895951Medicaid
FL1548616378Medicaid
FL1366635831Medicaid
FL1679171532OtherFAMILY MEDICINE
FL1013969898Medicaid
FL1952516742OtherPEDIATRICS