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General NPI Number Information
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NPI Number | 1699852319
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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 | 11/01/2006
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 5040 N 15TH AVE SUITE 202
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City | PHOENIX
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State | AZ
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Zip | 85015-3328
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Country | US
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Telephone | 602-248-0123
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Fax | 602-248-8506
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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 | 602-248-0123
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Fax | 602-248-8506
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. NATHAN A. 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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