Healthcare Provider Details

I. General information

NPI: 1922314053
Provider Name (Legal Business Name): JOHN C. LINCOLN COMPREHENSIVE WOMEN'S CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19841 N 27TH AVE SUITE 204
PHOENIX AZ
85027-4003
US

IV. Provider business mailing address

PO BOX 9907
PHOENIX AZ
85068-0907
US

V. Phone/Fax

Practice location:
  • Phone: 623-780-0100
  • Fax: 623-492-9160
Mailing address:
  • Phone: 623-780-0100
  • Fax: 623-492-9160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

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