NPIMap

Organization Active NPI

Lincoln County Primary Care Center Inc

Doing business as Lincoln Education Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Hamlin, WV
National Provider Identifier
1013675461
Registry record updated Dec 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LINCOLN COUNTY PRIMARY CARE CENTER INC
Doing business as
Lincoln Education Wellness Center
Practice address
10 Marland Ave
Hamlin, WV 25523-1058
Phone
(304) 824-5806
Fax
(304) 824-5804
NPI assigned
Dec 2, 2021
Last updated
Dec 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Letitia Ann Weaver
Title
Credentialing Coordinator
Phone
(304) 824-5806

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

10 Marland Ave
Hamlin, WV 25523-1058

Mailing address

7400 Lynn Ave
Hamlin, WV 25523-1138
Phone (304) 824-5806

Other identifiers 1

IdentifierTypeStateIssuer
2410-9259OtherWVBUSINESS LICNESE

Other names 1

  • Lincoln Education Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220126001660 WV Part A Provider - Federally Qualified Health Center (FQHC) 6204821879 Practice locations: Hamlin, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013675461. Details of each certification follow.

Federally qualified health center certification: CCN 581816

Legal name
LINCOLN COUNTY PRIMARY CARE CENTER INC
Doing business as
LINCOLN EDUCATION WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 21, 2022
Last certification
Jan 21, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
10 Marland Ave
Hamlin, WV 25523-1058

Other NPIs with the same Medicare PAC ID 24

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Lincoln Primary Care Ce22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Audrey Robinette Individual Corporate DirectorBoard Member Jul 1, 2020
Rebecca Farmer Individual Corporate DirectorBoard Member Jul 1, 2017
Brian Vance Individual Corporate DirectorBoard Member Jul 1, 2020
Jerry Lawson Individual Corporate DirectorBoard Member Jul 1, 2013
Letitia Weaver-Scites Individual W-2 Managing EmployeeCredentialing Coordinator Apr 11, 2012
Lisa Leach Individual Corporate OfficerCeo Jun 12, 2018
David Boggess Individual Corporate DirectorBoard Member Jul 1, 2018
Ronald McGrady Individual W-2 Managing EmployeeCao Mar 8, 2012
Nancy Godby Individual Corporate DirectorBoard Member Jul 1, 2018
Courtney Cooper Individual Corporate DirectorBoard Member Jul 1, 2016
Priscilla Byrnside Individual Corporate DirectorBoard Member Jul 1, 2020
Lori Huffman Individual Corporate DirectorBoard Member Jul 1, 2021
Dana Snyder Individual Corporate DirectorBoard Member Jul 1, 2020

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638403200000",
    "number": "1013675461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 LYNN AVE",
            "city": "HAMLIN",
            "state": "WV",
            "postal_code": "255231138",
            "telephone_number": "304-824-5806",
            "fax_number": "304-824-5804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MARLAND AVE",
            "city": "HAMLIN",
            "state": "WV",
            "postal_code": "255231058",
            "telephone_number": "304-824-5806",
            "fax_number": "304-824-5804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN COUNTY PRIMARY CARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-02",
        "last_updated": "2021-12-02",
        "certification_date": "2021-11-19",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "LETITIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "304-824-5806"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICNESE",
            "identifier": "2410-9259",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lincoln Education Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hamlin, WV

Sources for this page

Verify at the official NPI Registry.