=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619008877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LINCOLN COUNTY MEDICINE & PEDIATRICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1165B E CHERRY ST
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63379-1520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-528-1919
-----------------------------------------------------
Fax | 636-528-1916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1165B E CHERRY ST
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63379-1520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-528-1919
-----------------------------------------------------
Fax | 636-528-1916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | JAMES L BOCKHORST
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 636-528-1919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 111051
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 2003002316
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 2003002316
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------