Provider Demographics
NPI:1023350006
Name:LINCOLN CENTER CLINIC
Entity type:Organization
Organization Name:LINCOLN CENTER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:R. ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-288-2892
Mailing Address - Street 1:1 LINCOLN PKWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3262
Mailing Address - Country:US
Mailing Address - Phone:601-296-7848
Mailing Address - Fax:601-296-7828
Practice Address - Street 1:1 LINCOLN PKWY
Practice Address - Street 2:SUITE 302
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3262
Practice Address - Country:US
Practice Address - Phone:601-296-7848
Practice Address - Fax:601-296-7828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORREST COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty