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General NPI Number Information
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NPI Number | 1255489910
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Entity Type | Organization
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Legal Business Name | LEWIS COUNTY PRIMARY CARE CENTER, INC.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 04/12/2010
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Provider Practice Location Address
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Address Line | 927 KENTON STATION DR
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City | MAYSVILLE
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State | KY
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Zip | 41056-9609
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Country | US
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Telephone | 606-796-3029
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Fax | 606-796-6221
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Provider Business Mailing Address
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Address Line | PO BOX 550
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City | VANCEBURG
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State | KY
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Zip | 41179-0550
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Country | US
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Telephone | 606-796-3029
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Fax | 606-796-6221
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Authorized Official
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Title or Position | CEO
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Name | MR. JERRY G UGRIN
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Credential |
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Telephone | 606-796-3029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 700041
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License Number State | KY
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