Provider Demographics
NPI:1619076296
Name:LINCOLN MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:LINCOLN MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:Q
Authorized Official - Last Name:SAJID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-769-0317
Mailing Address - Street 1:1815 N DIXIE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9424
Mailing Address - Country:US
Mailing Address - Phone:270-769-0317
Mailing Address - Fax:270-769-0318
Practice Address - Street 1:1815 N DIXIE HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9424
Practice Address - Country:US
Practice Address - Phone:270-769-0317
Practice Address - Fax:270-769-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY268229332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2812641000OtherPASSPORT ADVANTAGE
KY000000505127OtherANTHEM
KY50013434OtherPASSPORT
KY612251300OtherBLACK LUNG
KY90013954Medicaid
KY=========OtherTAX ID #