Provider Demographics
NPI:1295123081
Name:LINCOLN MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:LINCOLN MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:SHERRARD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:318-224-7004
Mailing Address - Street 1:1831 NORTH TRENTON STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2678
Mailing Address - Country:US
Mailing Address - Phone:318-224-7004
Mailing Address - Fax:318-224-7006
Practice Address - Street 1:1831 NORTH TRENTON STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2678
Practice Address - Country:US
Practice Address - Phone:318-224-7004
Practice Address - Fax:318-224-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty