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General NPI Number Information
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NPI Number | 1184278483
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Entity Type | Organization
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Legal Business Name | MAMMOLINK LLC
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 3982 WOODLAND RETREAT BLVD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-4593
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Country | US
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Telephone | 844-546-5871
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Fax | 844-546-5871
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Provider Business Mailing Address
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Address Line | 3982 WOODLAND RETREAT BLVD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-4593
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Country | US
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Telephone | 844-546-5871
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Fax | 844-546-5871
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Authorized Official
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Title or Position | OWNER
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Name | RYAN JOSEPH POLSELLI
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Credential | MD
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Telephone | 912-667-8654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0207X
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Taxonomy Name | Mobile Mammography Clinic/Center
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License Number |
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License Number State |
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