Basic Information
| Provider Information | |||||||||
| NPI: | 1912111626 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LINCOLN MEDICAL SUPPLIES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3359 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600762432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476796725 | ||||||||
| FaxNumber: | 8476797377 | ||||||||
| Practice Location | |||||||||
| Address1: | 3359 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600762432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476796725 | ||||||||
| FaxNumber: | 8476797377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MAUER | ||||||||
| AuthorizedOfficialFirstName: | MARSHALL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8476796725 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | 20500078 | IL | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition |
No ID Information.