Healthcare Provider Details

I. General information

NPI: 1770704520
Provider Name (Legal Business Name): MEDLINK MANAGEMENT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 SE 3RD AVE
LAKE BUTLER FL
32054-2647
US

IV. Provider business mailing address

PO BOX 744
LAKE BUTLER FL
32054-0744
US

V. Phone/Fax

Practice location:
  • Phone: 386-496-2461
  • Fax: 386-496-0806
Mailing address:
  • Phone: 386-496-2461
  • Fax: 386-496-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberME0037535
License Number StateFL

VIII. Authorized Official

Name: MRS. PAULA GAY WEBB
Title or Position: PRESIDENT,CFO
Credential:
Phone: 386-496-2323