Healthcare Provider Details

I. General information

NPI: 1891246773
Provider Name (Legal Business Name): JOHN C LINCOLN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE SUITE 308
PHOENIX AZ
85027-4013
US

IV. Provider business mailing address

2500 W UTOPIA RD SUITE 100
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 623-780-1999
  • Fax: 623-516-0950
Mailing address:
  • Phone: 623-434-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number StateAZ

VIII. Authorized Official

Name: NATHAN ANSPACH
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 623-434-6200