Lincoln County Primary Care Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Branchland, WV
NPI 1255521027 · NPPES record last updated Mar 8, 2023
Key facts
- NPI
- 1255521027
- 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
- 5322 McClellan Hwy
Branchland, WV 25506-8725 - Phone
- (304) 824-5707
- Fax
- (304) 824-5706
- NPI assigned
- Jul 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Lisa Leach
- Title
- Ceo
- Phone
- (304) 824-5806
Other NPIs on the same Medicare enrollment 7
Other NPIs with the same Medicare PAC ID 24
Practitioners 53
-
Lisa Adkins, FNP
-
Jackson B Austin, PA-C
-
Rebel Renea Christian, FNP-BC
-
Sidney Jerome Cline, APRN
-
Haley Crum, FNP-BC
-
Sarah Alice Curry, M.D.
-
Rikki Lynn Evans, FNP-C
-
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
-
Mary Jane Phipps, FNP
-
Leanna Carlyn Profitt, FNP-BC
-
Courtney Kovach Reynolds, PA C
-
Alyssa Michele Skeens, FNP-BC
-
Candice Stacy, FNP-BC
-
Mara Wright Sutphin, P.A.-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 51D0912467 | Guyan Valley Wellness Center | Certificate of waiver | Mar 4, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Federally qualified health center certification: CCN 511935
- Legal name
- LINCOLN COUNTY PRIMARY CARE CENTER INC
- Doing business as
- GUYAN VALLEY WELLNESS CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Feb 26, 2008
- Last certification
- Feb 26, 2008
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 30, 1975 in WV
- Enrollment address
- 5322 McClellan Highway
Branchland, WV 25506-8725
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Brian Vance |
Corporate Director |
Jul 1, 2020 | |
| Debrina Williams |
Corporate Director |
Jul 1, 2023 | |
| Jerry Lawson |
Corporate Director |
Jul 1, 2017 | |
| Letitia Weaver-Scites |
W-2 Managing Employee |
Apr 11, 2012 | |
| Lisa Leach |
Corporate Officer |
Mar 31, 2018 | |
| Priscilla Byrnside |
Corporate Director |
Jul 1, 2020 | |
| Christy Laxton |
Corporate Director |
Jul 1, 2023 | |
| Lori Huffman |
Corporate Director |
Jul 1, 2021 | |
| Karl Melkus |
Corporate Director |
Jul 1, 2023 | |
| Dana Snyder |
Corporate Director |
Jul 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040415000138 | WV | Part B Supplier - Public Health/Welfare Agency | 6204821879 |
Receives reassigned benefits from 60 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Branchland, WV; Chapmanville, WV; Delbarton, WV; Gilbert, WV; Hamlin, WV; Logan, WV; Man, WV; Salt Rock, WV |
| O20080111000489 | WV | Part a Provider - Federally Qualified Health Center (FQHC) | 6204821879 |
1 other NPI on this enrollment Practice locations: Branchland, WV |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
5322 McClellan Hwy
Branchland, WV 25506-8725
Mailing address
7400 Lynn Ave
Hamlin, WV 25523-1138
Phone (304) 824-5806
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810011864 | Medicaid | WV | |
| CA9760 | Other | WV | RR MEDICARE GROUP |
Other names
- Guyan Valley Wellness Center
Other providers in Branchland, WV
- Jacqueline Jeffery
- Russell Jeffrey
- Rachael Kelley
- Chassity Kirk
- Lincoln County Primary Care Center, Inc
- Patricia Ann London
- Earl Jean Mansfield
- Julie Mays
- Sheila Ann Mays
- Misty McCallister
All providers in Branchland, 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 Mar 8, 2023. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.