Provider Demographics
NPI:1871843326
Name:JOHN C. LINCOLN, LLC
Entity Type:Organization
Organization Name:JOHN C. LINCOLN, LLC
Other - Org Name:JOHN C. LINCOLN LIFESTREAM AT YOUNGTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. 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: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:623-434-6155
Mailing Address - Fax:623-434-6149
Practice Address - Street 1:10800 N 115TH AVE
Practice Address - Street 2:SUITE 94
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1436
Practice Address - Country:US
Practice Address - Phone:602-544-8541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN C. LINCOLN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty