=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306274634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDI-LYNX CARDIAC MONITORING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2013
-----------------------------------------------------
Last Update Date | 09/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6700 PINECREST DR
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-4263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-847-0780
-----------------------------------------------------
Fax | 855-847-1023
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6700 PINECREST DR SUITE 200
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-4263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-847-0780
-----------------------------------------------------
Fax | 855-847-1023
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | PETER PELLERITO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-448-2119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 293D00000X
-----------------------------------------------------
Taxonomy Name | Physiological Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------