MEDICARE: JOHN C. LINCOLN, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1003107921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN C. LINCOLN, LLC

Provider Business Mailing Address
First Line	:	2500 W UTOPIA RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4171
Country	:	US
Telephone Number	:	623-780-3751
Fax Number	:

Provider Business Practice Location Address
First Line	:	46641 N BLACK CANYON HWY
Second Line	:	STE. 5
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-6941
Country	:	US
Telephone Number	:	623-465-8810
Fax Number	:	623-465-1561

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	NATHAN ANSPACH
Credential	:
Telephone Number	:	623-780-3751

Provider Enumeration Date	:	04/26/2011
Last Update Date	:	04/26/2011

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Directions to “JOHN C. LINCOLN, LLC ” Practice Location

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