Provider Demographics
NPI:1831223635
Name:LINCOLN MEDICAL CENTER
Entity type:Organization
Organization Name:LINCOLN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:N
Authorized Official - Last Name:GROCE
Authorized Official - Suffix:
Authorized Official - Credentials:CNO, CRNP
Authorized Official - Phone:931-438-7469
Mailing Address - Street 1:106 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2684
Mailing Address - Country:US
Mailing Address - Phone:931-438-7456
Mailing Address - Fax:
Practice Address - Street 1:1681 WINCHESTER HWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2758
Practice Address - Country:US
Practice Address - Phone:931-438-4624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINCOLN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000085273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44S102Medicare Oscar/Certification