1235172925 NPI number — PHYSICIANS LINK CENTER LLC

Table of content: (NPI 1235172925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235172925 NPI number — PHYSICIANS LINK CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS LINK CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235172925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12420 MILESTONE CENTER DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20876-7111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-862-3002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 E RIVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELYRIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44035-5902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-474-4019
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHARLEY
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF LEGAL OFFICER
Authorized Official Telephone Number:
240-686-2300

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000214870 . This is a "ANTHEM OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 127920900 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: CK2882 . This is a "MEDICARE TRAVELERS RR - G" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 029281000 . This is a "FEDERAL BLACK LUNG PROGRA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 127920901 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 012956800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".