Healthcare Provider Details

I. General information

NPI: 1003107921
Provider Name (Legal Business Name): JOHN C. LINCOLN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46641 N BLACK CANYON HWY STE. 5
NEW RIVER AZ
85087-6941
US

IV. Provider business mailing address

2500 W UTOPIA RD
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 623-465-8810
  • Fax: 623-465-1561
Mailing address:
  • Phone: 623-780-3751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NATHAN ANSPACH
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 623-780-3751