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General NPI Number Information
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NPI Number | 1003107921
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Entity Type | Organization
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Legal Business Name | JOHN C. LINCOLN, LLC
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 46641 N BLACK CANYON HWY STE. 5
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City | NEW RIVER
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State | AZ
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Zip | 85087-6941
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Country | US
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Telephone | 623-465-8810
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Fax | 623-465-1561
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Provider Business Mailing Address
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Address Line | 2500 W UTOPIA RD
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City | PHOENIX
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State | AZ
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Zip | 85027-4171
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Country | US
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Telephone | 623-780-3751
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | NATHAN ANSPACH
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Credential |
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Telephone | 623-780-3751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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