Healthcare Provider Details

I. General information

NPI: 1467925487
Provider Name (Legal Business Name): LINCOLN COUNTY PRIMARY CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 03/11/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 LARRY JOE HARLESS DR
GILBERT WV
25621
US

IV. Provider business mailing address

7400 LYNN AVE
HAMLIN WV
25523-1138
US

V. Phone/Fax

Practice location:
  • Phone: 304-664-1147
  • Fax: 304-664-1199
Mailing address:
  • Phone: 304-824-5806
  • Fax: 304-824-5885

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: LETITIA ANN WEAVER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 304-824-5806