Provider Demographics
NPI:1649357955
Name:LINCOLN FAMILY PRACTICE ASSOCIATES INC.
Entity type:Organization
Organization Name:LINCOLN FAMILY PRACTICE ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHARE HOLDER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:916-434-1623
Mailing Address - Street 1:160 GATEWAY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-3319
Mailing Address - Country:US
Mailing Address - Phone:916-434-1623
Mailing Address - Fax:916-434-1625
Practice Address - Street 1:160 GATEWAY DR STE 110
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-3319
Practice Address - Country:US
Practice Address - Phone:916-434-1623
Practice Address - Fax:916-434-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02979ZMedicare ID - Type UnspecifiedNHIC
CAQ23972Medicare UPIN