Healthcare Provider Details

I. General information

NPI: 1902048010
Provider Name (Legal Business Name): LINCOLN MEDICAL CENTER HOSPITALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MEDICAL CENTER BLVD
FAYETTEVILLE TN
37334-2684
US

IV. Provider business mailing address

106 MEDICAL CENTER BLVD
FAYETTEVILLE TN
37334-2684
US

V. Phone/Fax

Practice location:
  • Phone: 931-438-7482
  • Fax: 931-438-7447
Mailing address:
  • Phone: 931-438-7482
  • Fax: 931-438-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID RAY GROCE
Title or Position: CFO
Credential:
Phone: 931-438-7471