Basic Information
| Provider Information | |||||||||
| NPI: | 1497197677 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN C. LINCOLN, LLC | ||||||||
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| OtherOrganizationName: | JOHN C. LINCOLN GLENDALE FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 W UTOPIA RD | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850274171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234346200 | ||||||||
| FaxNumber: | 6234346164 | ||||||||
| Practice Location | |||||||||
| Address1: | 6677 W THUNDERBIRD RD | ||||||||
| Address2: | STE. A124 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853063709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6237732266 | ||||||||
| FaxNumber: | 6237732267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2013 | ||||||||
| LastUpdateDate: | 07/29/2013 | ||||||||
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| AuthorizedOfficialLastName: | ANSPACH | ||||||||
| AuthorizedOfficialFirstName: | NATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6234346200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.