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NPI Code Detail

MEDICARE: LINCOLN COUNTY PRIMARY CARE CENTER, INC

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
1261QF0400XFederally Qualified Health Center (FQHC)

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CA9760OTHERWVMEDICARE RR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962583054
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 : 81 LINCOLN PANTHER WAY
Second Line :
City : HAMLIN
State : WV
Zip : 25523-1169
Country : US
Telephone Number : 304-824-6090
Fax Number : 304-824-6094
Authorized Official
Title or Position : CEO
Name : LISA LEACH
Credential :
Telephone Number : 304-824-5806
Provider Enumeration Date : 10/17/2006
Last Update Date : 03/08/2023

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Directions to “LINCOLN COUNTY PRIMARY CARE CENTER, INC ” Practice Location

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