Provider Demographics
NPI:1023299823
Name:LINCOLN MEDICAL CENTER SURGICAL CLINIC
Entity type:Organization
Organization Name:LINCOLN MEDICAL CENTER SURGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GROCE
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:931-438-7471
Mailing Address - Street 1:108 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2741
Mailing Address - Country:US
Mailing Address - Phone:931-438-1100
Mailing Address - Fax:931-438-7491
Practice Address - Street 1:108 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2741
Practice Address - Country:US
Practice Address - Phone:931-438-1100
Practice Address - Fax:931-438-7491
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINCOLN COUNTY HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX ID