Healthcare Provider Details

I. General information

NPI: 1124467956
Provider Name (Legal Business Name): JOHN C. LINCOLN NORTH MOUNTAIN PROFESSIONALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 N 3RD ST SUITE 103
PHOENIX AZ
85020-2439
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 623-434-6200
  • Fax:
Mailing address:
  • Phone: 623-434-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. NATHAN ANSPACH
Title or Position: SR. VP
Credential:
Phone: 623-434-6200