| Entity Name: | OPTUM INFUSION SERVICES 204, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Oct 2002 (22 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 16 Sep 2020 (4 years ago) |
| Document Number: | P02000113258 |
| FEI/EIN Number | 55-0802774 |
| Address: | 15529 College Blvd., Lenexa, KS, 66219-1351, US |
| Mail Address: | 15529 College Blvd., Lenexa, KS, 66219-1351, US |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | OPTUM INFUSION SERVICES 204, INC., ALABAMA | 000-533-341 | ALABAMA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588936785 | 2012-02-02 | 2022-12-29 | 4220 EXECUTIVE CIRCLE, SUITE 62, FORT MYERS, FL, 33916, US | 4220 EXECUTIVE CIRCLE, SUITE 62, FORT MYERS, FL, 33916, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 239-561-2388 |
| Fax | 8448301983 |
Authorized person
| Name | DAVID JOHN OBERG |
| Role | ASSISTANT SECRETARY |
| Phone | 9499885893 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | No |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| License Number | PH 27821 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 3336H0001X - Home Infusion Therapy Pharmacy |
| License Number | PH26240 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 015940200 |
| State | FL |
| Issuer | MEDICAID |
| Number | 015940201 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| Lang Heather A | Asst | 15529 College Blvd., Lenexa, KS, 662191351 |
| Name | Role | Address |
|---|---|---|
| Satterwhite Erin A | President | 15529 College Blvd., Lenexa, KS, 662191351 |
| Name | Role | Address |
|---|---|---|
| Carey Kathryn E | Director | 15529 College Blvd., Lenexa, KS, 662191351 |
| Name | Role | Address |
|---|---|---|
| Burr Kevin E | Secretary | 15529 College Blvd., Lenexa, KS, 662191351 |
| Name | Role | Address |
|---|---|---|
| Hirsch Marilyn V | Treasurer | 15529 College Blvd., Lenexa, KS, 662191351 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2020-09-16 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-05-20 | 15529 College Blvd., Lenexa, KS 66219-1351 | No data |
| CHANGE OF MAILING ADDRESS | 2020-05-20 | 15529 College Blvd., Lenexa, KS 66219-1351 | No data |
| NAME CHANGE AMENDMENT | 2020-04-02 | OPTUM INFUSION SERVICES 204, INC. | No data |
| AMENDMENT AND NAME CHANGE | 2017-08-17 | BRIOVARX INFUSION SERVICES 204, INC. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-05-16 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-05-16 | CT CORPORATION SYSTEM | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-10-01 |
| AMENDED ANNUAL REPORT | 2024-07-09 |
| ANNUAL REPORT | 2024-04-21 |
| ANNUAL REPORT | 2023-04-22 |
| ANNUAL REPORT | 2022-04-20 |
| ANNUAL REPORT | 2021-04-24 |
| Amendment | 2020-09-16 |
| ANNUAL REPORT | 2020-05-20 |
| Name Change | 2020-04-02 |
| ANNUAL REPORT | 2019-03-23 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
