Provider Demographics
NPI:1740893999
Name:LEWIS COUNTY PRIMARY CARE CENTER, INC
Entity type:Organization
Organization Name:LEWIS COUNTY PRIMARY CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:606-956-0188
Mailing Address - Street 1:927 KENTON STATION DR
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-9617
Mailing Address - Country:US
Mailing Address - Phone:606-759-1189
Mailing Address - Fax:
Practice Address - Street 1:645 INTERSTATE DRIVE
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143
Practice Address - Country:US
Practice Address - Phone:606-898-0209
Practice Address - Fax:606-898-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy