Healthcare Provider Details

I. General information

NPI: 1740893999
Provider Name (Legal Business Name): LEWIS COUNTY PRIMARY CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 INTERSTATE DRIVE
GRAYSON KY
41143
US

IV. Provider business mailing address

927 KENTON STATION DR
MAYSVILLE KY
41056-9617
US

V. Phone/Fax

Practice location:
  • Phone: 606-898-0209
  • Fax: 606-898-0210
Mailing address:
  • Phone: 606-759-1189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHAD ERWIN EVANS
Title or Position: CHIEF CLINICAL OFFICER
Credential: PHARMD
Phone: 606-956-0188