MEDICARE: JOHN C. LINCOLN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1639426422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN C. LINCOLN, LLC

Provider Business Mailing Address
First Line	:	41810 N VENTURE DR
Second Line	:	E160
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3169
Country	:	US
Telephone Number	:	623-465-4627
Fax Number	:	623-594-8919

Provider Business Practice Location Address
First Line	:	41810 N VENTURE DR
Second Line	:	E160
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3169
Country	:	US
Telephone Number	:	623-465-4627
Fax Number	:	623-594-8919

Authorized Official
Title or Position	:	SR. VP
Name	:	NATHAN ANSPACH
Credential	:
Telephone Number	:	623-434-6200

Provider Enumeration Date	:	08/10/2012
Last Update Date	:	08/10/2012

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