Provider Demographics
NPI:1194839217
Name:JOHN C. LINCOLN LLC
Entity Type:Organization
Organization Name:JOHN C. LINCOLN LLC
Other - Org Name:SOUTHWEST ENDOCRINOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-516-8637
Mailing Address - Street 1:PO BOX 9907
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068-0907
Mailing Address - Country:US
Mailing Address - Phone:602-249-2490
Mailing Address - Fax:602-249-2555
Practice Address - Street 1:9225 N 3RD ST
Practice Address - Street 2:SUITE 307
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2439
Practice Address - Country:US
Practice Address - Phone:602-249-2490
Practice Address - Fax:602-249-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ830548Medicaid
76451Medicare ID - Type UnspecifiedMANJU SCHORR, MD
H94755Medicare UPIN