Healthcare Provider Details

I. General information

NPI: 1538284401
Provider Name (Legal Business Name): LEWIS COUNTY PRIMARY CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 KENTON STATION DR
MAYSVILLE KY
41056-9609
US

IV. Provider business mailing address

PO BOX 550
VANCEBURG KY
41179-0550
US

V. Phone/Fax

Practice location:
  • Phone: 606-759-5331
  • Fax: 606-759-5363
Mailing address:
  • Phone: 606-796-3029
  • Fax: 606-796-6221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number700041
License Number StateKY

VIII. Authorized Official

Name: JERRY UGRIN
Title or Position: CEO
Credential:
Phone: 606-796-3029