Provider Demographics
NPI:1184278483
Name:MAMMOLINK LLC
Entity type:Organization
Organization Name:MAMMOLINK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:POLSELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-667-8654
Mailing Address - Street 1:3982 WOODLAND RETREAT BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4593
Mailing Address - Country:US
Mailing Address - Phone:844-546-5871
Mailing Address - Fax:844-546-5871
Practice Address - Street 1:3982 WOODLAND RETREAT BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-4593
Practice Address - Country:US
Practice Address - Phone:844-546-5871
Practice Address - Fax:844-546-5871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty