MEDICARE: LINCOLN COUNTY PRIMARY CARE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1841596277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOLN COUNTY PRIMARY CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	7400 LYNN AVE
Second Line	:
City	:	HAMLIN
State	:	WV
Zip	:	25523-1138
Country	:	US
Telephone Number	:	304-824-5806
Fax Number	:	304-824-5885

Provider Business Practice Location Address
First Line	:	2508 STRAIGHT FORK RD
Second Line	:
City	:	ALKOL
State	:	WV
Zip	:	25501
Country	:	US
Telephone Number	:	304-824-5806
Fax Number	:	304-824-5885

Authorized Official
Title or Position	:	CEO
Name	:	LISA LEACH
Credential	:
Telephone Number	:	304-824-5806

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	10/02/2018

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