Provider Demographics
NPI:1497197677
Name:JOHN C. LINCOLN, LLC
Entity Type:Organization
Organization Name:JOHN C. LINCOLN, LLC
Other - Org Name:JOHN C. LINCOLN GLENDALE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSPACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-434-6200
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:623-434-6200
Mailing Address - Fax:623-434-6164
Practice Address - Street 1:6677 W THUNDERBIRD RD
Practice Address - Street 2:STE. A124
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3709
Practice Address - Country:US
Practice Address - Phone:623-773-2266
Practice Address - Fax:623-773-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty