Basic Information
Provider Information | |||||||||
NPI: | 1447619416 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LINCOLN COUNTY PRIMARY CARE CENTER, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | PIONEER HEALTH CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7400 LYNN AVE | ||||||||
Address2: |   | ||||||||
City: | HAMLIN | ||||||||
State: | WV | ||||||||
PostalCode: | 255231138 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3048245806 | ||||||||
FaxNumber: | 3048245885 | ||||||||
Practice Location | |||||||||
Address1: | 1 PIONEER PATH | ||||||||
Address2: |   | ||||||||
City: | MAN | ||||||||
State: | WV | ||||||||
PostalCode: | 256351235 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3045837295 | ||||||||
FaxNumber: | 3045837436 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/18/2016 | ||||||||
LastUpdateDate: | 10/02/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LECH | ||||||||
AuthorizedOfficialFirstName: | LISA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 3048245806 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | 2318-9519 | WV | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.