Provider Demographics
NPI:1699852319
Name:JOHN C. LINCOLN, LLC
Entity Type:Organization
Organization Name:JOHN C. LINCOLN, LLC
Other - Org Name:SUN VALLEY FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANSPACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-780-3751
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:602-248-0123
Mailing Address - Fax:602-248-8506
Practice Address - Street 1:5040 N 15TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3328
Practice Address - Country:US
Practice Address - Phone:602-248-0123
Practice Address - Fax:602-248-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWDCDMMedicare PIN