Provider Demographics
NPI:1114188927
Name:MEDLINK MANAGEMENT SERVICES INC
Entity Type:Organization
Organization Name:MEDLINK MANAGEMENT SERVICES INC
Other - Org Name:LAKE BUTLER FAMILY & PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-496-2323
Mailing Address - Street 1:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-0748
Mailing Address - Country:US
Mailing Address - Phone:386-496-1922
Mailing Address - Fax:386-496-4777
Practice Address - Street 1:575 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-2647
Practice Address - Country:US
Practice Address - Phone:386-496-1922
Practice Address - Fax:386-496-4777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDLINK MANAGEMENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-24
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800012290261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660083200Medicaid
FL103424Medicare Oscar/Certification