Basic Information
| Provider Information | |||||||||
| NPI: | 1225026321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINK | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 800 EAST CARPENTER STREET | ||||||||
| Address2: | ROOM 2K64 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627690001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175255643 | ||||||||
| FaxNumber: | 2175442521 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 EAST CARPENTER STREET | ||||||||
| Address2: | ROOM 2K64 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627690001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175255643 | ||||||||
| FaxNumber: | 2175442521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 01/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 036093668 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 08415040 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER | 104409 | 01 | IL | HEALTHLINK GROUP NUMBER | OTHER | 291477 | 01 | IL | HEALTHLINK GROUP # | OTHER | 085972 | 01 | IL | HEALTH ALLIANCE | OTHER | L031806 | 01 | IL | CHAMPUS/TRICARE | OTHER | 036093668 | 05 | IL | MEDICAID | 32490 | 01 | IL | PERSONAL CARE | OTHER |