Healthcare Provider Details

I. General information

NPI: 1629542469
Provider Name (Legal Business Name): LEWIS COUNTY PRIMARY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 16TH ST
ASHLAND KY
41101-7693
US

IV. Provider business mailing address

211 KY 59 PO BOX 550
VANCEBURG KY
41179
US

V. Phone/Fax

Practice location:
  • Phone: 606-956-0188
  • Fax: 606-796-6010
Mailing address:
  • Phone: 606-956-0188
  • Fax: 606-796-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHAD ERWIN EVANS
Title or Position: DIRECTOR OF PHARMACY AND ANCILLARY
Credential: PHARMD
Phone: 606-956-0188