Provider Demographics
NPI:1629024914
Name:LINCOLN MEDICAL CENTER
Entity Type:Organization
Organization Name:LINCOLN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:N
Authorized Official - Last Name:GROCE
Authorized Official - Suffix:
Authorized Official - Credentials:CNO CRNP
Authorized Official - Phone:931-438-7469
Mailing Address - Street 1:106 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2684
Mailing Address - Country:US
Mailing Address - Phone:931-438-1100
Mailing Address - Fax:931-438-7456
Practice Address - Street 1:106 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2684
Practice Address - Country:US
Practice Address - Phone:931-438-1100
Practice Address - Fax:931-438-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000085282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN440102Medicare Oscar/Certification
TN44-3420Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC