Provider Demographics
NPI:1811165616
Name:LINCOLN MEDICAL CENTER CARDIOLOGY CLINIC
Entity type:Organization
Organization Name:LINCOLN MEDICAL CENTER CARDIOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO LINCOLN COUNTY HEALTH SYSTEM
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GROCE
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:931-438-1100
Mailing Address - Street 1:108 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2741
Mailing Address - Country:US
Mailing Address - Phone:931-438-7482
Mailing Address - Fax:931-438-7447
Practice Address - Street 1:108 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2741
Practice Address - Country:US
Practice Address - Phone:931-438-7482
Practice Address - Fax:931-438-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21295174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherEIN =========