Healthcare Provider Details

I. General information

NPI: 1881907384
Provider Name (Legal Business Name): LINCOLN MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22820 I-45 NORTH H-I
SPRING TX
77373-0000
US

IV. Provider business mailing address

PO BOX 9359
THE WOODLANDS TX
77387-9359
US

V. Phone/Fax

Practice location:
  • Phone: 281-288-8844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK E. FARIAS
Title or Position: MANAGER
Credential:
Phone: 281-288-8844