MEDICARE: LLD CONNECT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1659812501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LLD CONNECT, LLC

Provider Business Mailing Address
First Line	:	4540 SHADY BLOSSOM LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-7546
Country	:	US
Telephone Number	:	614-499-1037
Fax Number	:

Provider Business Practice Location Address
First Line	:	4540 SHADY BLOSSOM LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-7546
Country	:	US
Telephone Number	:	614-499-1037
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. ERNST R FISCHER
Credential	:
Telephone Number	:	614-499-1037

Provider Enumeration Date	:	03/12/2017
Last Update Date	:	03/12/2017

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Directions to “LLD CONNECT, LLC ” Practice Location

Language	Start Address	Practice Location

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