Provider Demographics
NPI:1598528564
Name:LINCOLN COUNTY PRIMARY CARE CENTER, INC
Entity Type:Organization
Organization Name:LINCOLN COUNTY PRIMARY CARE CENTER, INC
Other - Org Name:GUYAN VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LETITIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WEAVER-SCITES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-824-5806
Mailing Address - Street 1:7400 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1138
Mailing Address - Country:US
Mailing Address - Phone:304-824-5806
Mailing Address - Fax:304-824-5885
Practice Address - Street 1:5322 MCCLELLAN HWY
Practice Address - Street 2:
Practice Address - City:BRANCHLAND
Practice Address - State:WV
Practice Address - Zip Code:25506-8725
Practice Address - Country:US
Practice Address - Phone:681-500-7277
Practice Address - Fax:681-500-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2455-9083OtherBUSINESS LICENSE