Provider Demographics
NPI:1003142696
Name:LINCOLN CLINIC
Entity Type:Organization
Organization Name:LINCOLN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-332-0933
Mailing Address - Street 1:PO BOX K
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-1979
Mailing Address - Country:US
Mailing Address - Phone:512-332-0933
Mailing Address - Fax:512-332-0933
Practice Address - Street 1:3971 HWY 71 E
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-5121
Practice Address - Country:US
Practice Address - Phone:512-332-0933
Practice Address - Fax:512-332-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service