Provider Demographics
NPI:1578885620
Name:LINCOLN MEDICAL GROUP
Entity Type:Organization
Organization Name:LINCOLN MEDICAL GROUP
Other - Org Name:LINCOLN MEDICAL OB/GYN CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:LONIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-438-7455
Mailing Address - Street 1:108 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334
Mailing Address - Country:US
Mailing Address - Phone:931-433-1105
Mailing Address - Fax:931-433-1171
Practice Address - Street 1:108 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334
Practice Address - Country:US
Practice Address - Phone:931-433-1105
Practice Address - Fax:931-433-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========Medicare UPIN
TN=========Medicare PIN
TN=========Medicaid