Basic Information
| Provider Information | |||||||||
| NPI: | 1235172925 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS LINK CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12420 MILESTONE CENTER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208767111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068623002 | ||||||||
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| Practice Location | |||||||||
| Address1: | 630 E RIVER ST | ||||||||
| Address2: | |||||||||
| City: | ELYRIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440355902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2406862300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 06/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHARLEY | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF LEGAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2406862300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | ESQ | ||||||||
| NPICertificationDate: | 06/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000214870 | 01 | OH | ANTHEM OHIO | OTHER | 029281000 | 01 | OH | FEDERAL BLACK LUNG PROGRA | OTHER | 127920900 | 01 | OH | US DEPT OF LABOR | OTHER | 127920901 | 01 | OH | US DEPT OF LABOR | OTHER | CK2882 | 01 | OH | MEDICARE TRAVELERS RR - G | OTHER |