Lincoln County Primary Care Center Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Hamlin, WV
NPI 1013675461 · NPPES record last updated Dec 2, 2021
Key facts
- NPI
- 1013675461
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- LINCOLN COUNTY PRIMARY CARE CENTER INC
- Practice address
- 10 Marland Ave
Hamlin, WV 25523-1058 - Phone
- (304) 824-5806
- Fax
- (304) 824-5804
- NPI assigned
- Dec 2, 2021
- Organization subpart
- No
Authorized official
- Name
- Letitia Ann Weaver
- Title
- Credentialing Coordinator
- Phone
- (304) 824-5806
Other NPIs with the same Medicare PAC ID 24
Corporate family (same tax ID) 21
Practitioners 40
-
Lisa Adkins, FNP
-
Mary Rogers Aldred-Crouch, MSW, MPH, LICSW, MAC
-
Jackson B Austin, PA-C
-
Rebel Renea Christian, FNP-BC
-
Sidney Jerome Cline, APRN
-
Haley Crum, FNP-BC
-
Sarah Alice Curry, M.D.
-
Timothy Deskins, PA-C
-
Victoria Nicole Ellis, PA-C
-
Rikki Lynn Evans, FNP-C
-
Leevetta Lynn Holstein, APRN-FNP
-
Steven Lee Jarvis, APRN
-
Michelle Justice, NP
-
Melissa Rena Kijewski, D.O.
-
Chassity Kirk, APRN-FNP-BC
-
George L McKay, MD
-
Barbara Jean McNally, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
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
- Corporation · Non-profit
- Enrollment address
- 10 Marland Ave
Hamlin, WV 25523-1058
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Audrey Robinette |
Corporate Director |
Jul 1, 2020 | |
| Rebecca Farmer |
Corporate Director |
Jul 1, 2017 | |
| Brian Vance |
Corporate Director |
Jul 1, 2020 | |
| Jerry Lawson |
Corporate Director |
Jul 1, 2013 | |
| Letitia Weaver-Scites |
W-2 Managing Employee |
Apr 11, 2012 | |
| Lisa Leach |
Corporate Officer |
Jun 12, 2018 | |
| David Boggess |
Corporate Director |
Jul 1, 2018 | |
| Ronald McGrady |
W-2 Managing Employee |
Mar 8, 2012 | |
| Nancy Godby |
Corporate Director |
Jul 1, 2018 | |
| Courtney Cooper |
Corporate Director |
Jul 1, 2016 | |
| Priscilla Byrnside |
Corporate Director |
Jul 1, 2020 | |
| Lori Huffman |
Corporate Director |
Jul 1, 2021 | |
| Dana Snyder |
Corporate Director |
Jul 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220126001660 | WV | Part a Provider - Federally Qualified Health Center (FQHC) | 6204821879 | Practice locations: Hamlin, WV |
National Provider Directory
- Tax ID family
- Man Rexcellence Program
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2410-9259 | Other | WV | BUSINESS LICNESE |
Other names
- Lincoln Education Wellness Center
Other providers in Hamlin, WV
- Lincoln County Opportunity Company Inc
- Lincoln County Opportunity Company, Inc.
- Lincoln County Opportunity Company, Inc.
- Lincoln County Opportunity Company, Inc.
- Lincoln County Opportunity Company, Inc.
- Lincoln County Primary Care Center Inc
- Lincoln County Primary Care Center Inc
- Lincoln County Primary Care Center Inc
- Lincoln County Primary Care Center, Inc
- Lincoln County Primary Care Center, Inc.
All providers in Hamlin, WV · Federally Qualified Health Center (FQHC) in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.