Healthcare Provider Details

I. General information

NPI: 1003142696
Provider Name (Legal Business Name): LINCOLN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3971 HWY 71 E
BASTROP TX
78602-5121
US

IV. Provider business mailing address

PO BOX K
BASTROP TX
78602-1979
US

V. Phone/Fax

Practice location:
  • Phone: 512-332-0933
  • Fax: 512-332-0933
Mailing address:
  • Phone: 512-332-0933
  • Fax: 512-332-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. GWEN SMITH
Title or Position: TREASURER
Credential:
Phone: 512-332-0933