Provider Demographics
NPI:1053704254
Name:OPTIM ORTHOPEDICS, LLC
Entity type:Organization
Organization Name:OPTIM ORTHOPEDICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-644-5300
Mailing Address - Street 1:210 E DERENNE AVE
Mailing Address - Street 2:ATTN.: PROVIDER ENROLLMENT
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6736
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:101 W MULBERRY BLVD STE 140
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31407-3507
Practice Address - Country:US
Practice Address - Phone:912-748-5111
Practice Address - Fax:912-748-6699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIM ORTHOPEDICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty