Provider Demographics
NPI:1730445081
Name:LINCOLN WELLNESS CENTER
Entity type:Organization
Organization Name:LINCOLN WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:COUSER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:479-824-3000
Mailing Address - Street 1:573 N. COUNTY ROAD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:AR
Mailing Address - Zip Code:72744-0573
Mailing Address - Country:US
Mailing Address - Phone:479-824-3000
Mailing Address - Fax:479-824-3003
Practice Address - Street 1:573 N. COUNTY ROAD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:AR
Practice Address - Zip Code:72744-0573
Practice Address - Country:US
Practice Address - Phone:479-824-3000
Practice Address - Fax:479-824-3003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINCOLN PUBLIC SCHOOLS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty