Healthcare Provider Details

I. General information

NPI: 1699852319
Provider Name (Legal Business Name): JOHN C. LINCOLN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 N 15TH AVE SUITE 202
PHOENIX AZ
85015-3328
US

IV. Provider business mailing address

PO BOX 9907
PHOENIX AZ
85068-0907
US

V. Phone/Fax

Practice location:
  • Phone: 602-248-0123
  • Fax: 602-248-8506
Mailing address:
  • Phone: 602-248-0123
  • Fax: 602-248-8506

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: MR. NATHAN A. ANSPACH
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 623-780-3751