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General NPI Number Information
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NPI Number | 1679715940
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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 | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 9250 N 3RD ST SUITE 1002
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City | PHOENIX
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State | AZ
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Zip | 85020-2412
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Country | US
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Telephone | 602-216-6690
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9907
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City | PHOENIX
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State | AZ
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Zip | 85068-0907
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Country | US
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Telephone | 602-216-6690
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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 | MR. GARY R GROVER
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Credential |
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Telephone | 602-216-6687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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