Healthcare Provider Details

I. General information

NPI: 1205545878
Provider Name (Legal Business Name): LEWIS COUNTY PRIMARY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 KY 801 N
MOREHEAD KY
40351
US

IV. Provider business mailing address

PO BOX 550
VANCEBURG KY
41179-0550
US

V. Phone/Fax

Practice location:
  • Phone: 606-548-5546
  • Fax: 606-548-5547
Mailing address:
  • Phone: 606-956-0188
  • Fax: 606-956-0155

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: CHIEF CLINICAL OFFICER
Credential: PHARMD
Phone: 606-956-0188