Provider Demographics
NPI:1891561999
Name:OPTUM INFUSION CLINIC, LLC
Entity type:Organization
Organization Name:OPTUM INFUSION CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-205-7745
Mailing Address - Street 1:15529 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1351
Mailing Address - Country:US
Mailing Address - Phone:913-335-6786
Mailing Address - Fax:844-855-0868
Practice Address - Street 1:20414 N 27TH AVE STE 450
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-0002
Practice Address - Country:US
Practice Address - Phone:913-335-6786
Practice Address - Fax:844-855-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy