Provider Demographics
NPI:1457541229
Name:LINCOLN COUNTY PRIMARY CARE CENTER, INC.
Entity Type:Organization
Organization Name:LINCOLN COUNTY PRIMARY CARE CENTER, INC.
Other - Org Name:DUVAL MIDDLE SCHOOL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-824-5806
Mailing Address - Street 1:7400 LYNN AVENUE
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 1:5304 STRAIGHT FORK ROAD
Practice Address - Street 2:
Practice Address - City:GRIFFITHSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25521-9504
Practice Address - Country:US
Practice Address - Phone:304-524-9242
Practice Address - Fax:304-524-9241
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINCOLN COUNTY PRIMARY CARE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-27
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCA9760OtherMEDICARE RR
WV3810011411Medicaid
WV511910Medicare Oscar/Certification
WVF10500Medicare UPIN