1932471323 NPI number — JOHN C. LINCOLN GENETICS CANCER RISK

Table of content: (NPI 1932471323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932471323 NPI number — JOHN C. LINCOLN GENETICS CANCER RISK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN C. LINCOLN GENETICS CANCER RISK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932471323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 W UTOPIA RD
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85027-4171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-434-6200
Provider Business Mailing Address Fax Number:
623-780-3752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19646 N 27TH AVE
Provider Second Line Business Practice Location Address:
STE. 201
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85027-4017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-580-5390
Provider Business Practice Location Address Fax Number:
623-580-5397
Provider Enumeration Date:
02/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ANSPACH
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
623-780-3751

Provider Taxonomy Codes

  • Taxonomy code: 207SG0201X , with the licence number:  4612 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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