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General NPI Number Information
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NPI Number | 1598040347
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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 | 10/12/2011
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 18404 N TATUM BLVD STE. 102
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City | PHOENIX
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State | AZ
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Zip | 85032-1510
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Country | US
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Telephone | 602-485-7451
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Fax | 602-485-7450
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Provider Business Mailing Address
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Address Line | 2500 W UTOPIA RD STE. 100
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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 | 623-780-3752
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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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