Provider Demographics
NPI:1780631374
Name:LINCOLN COMMUNITY HEALTH CENTER INCORPORATED
Entity Type:Organization
Organization Name:LINCOLN COMMUNITY HEALTH CENTER INCORPORATED
Other - Org Name:WALLTOWN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CLARETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-956-4022
Mailing Address - Street 1:PO BOX 52119
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27717-2119
Mailing Address - Country:US
Mailing Address - Phone:919-956-4000
Mailing Address - Fax:919-956-4535
Practice Address - Street 1:815 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4137
Practice Address - Country:US
Practice Address - Phone:919-416-1254
Practice Address - Fax:919-416-1285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINCOLN COMMUNITY HEALTH CENTER INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344500CMedicaid
NC344500AMedicaid
NC03055OtherNC BC/BS ID NUMBER
NC2804138Medicare PIN
NC344500CMedicaid