1750363164 NPI number — HEALTHLINK FAMILY PRACTICE & SPORTS MEDICINE, INC.

Table of content: (NPI 1750363164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750363164 NPI number — HEALTHLINK FAMILY PRACTICE & SPORTS MEDICINE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHLINK FAMILY PRACTICE & SPORTS MEDICINE, INC.
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:
1750363164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6860 TYLERSVILLE RD
Provider Second Line Business Mailing Address:
SUITE 12
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45040-1236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-701-5510
Provider Business Mailing Address Fax Number:
513-701-5511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6860 TYLERSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
MASON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45040-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-701-5510
Provider Business Practice Location Address Fax Number:
513-701-5511
Provider Enumeration Date:
11/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LINKER
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-701-5510

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QS0010X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0057407 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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