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NPI Code Detail

MEDICARE: JOHN C LINCOLN LLC

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
1174400000XSpecialist

General Provider Information

NPI Number : 1982781167
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHN C LINCOLN LLC
Provider Business Mailing Address
First Line : 2302 W GREENWAY RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85023-4235
Country : US
Telephone Number : 602-942-2310
Fax Number : 602-942-1735
Provider Business Practice Location Address
First Line : 2302 W GREENWAY RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85023-4235
Country : US
Telephone Number : 602-942-2310
Fax Number : 602-942-1735
Authorized Official
Title or Position : SENIOR VP PND
Name : MR. GARY R GROVER
Credential :
Telephone Number : 623-516-8637
Provider Enumeration Date : 11/01/2006
Last Update Date : 12/07/2007

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