Healthcare Provider Details

I. General information

NPI: 1861624702
Provider Name (Legal Business Name): JOHN C. LINCOLN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1668 W GLENDALE AVE SUITE 128
PHOENIX AZ
85021-8948
US

IV. Provider business mailing address

PO BOX 9907
PHOENIX AZ
85068-0907
US

V. Phone/Fax

Practice location:
  • Phone: 623-780-1999
  • Fax: 623-516-0950
Mailing address:
  • Phone: 623-780-1999
  • Fax: 623-516-0950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

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