NPIMap

Organization Active NPI

Lincoln County Primary Care Center, Inc.

Doing business as Logan Wildcat Health Center

  • Federally Qualified Health Center (FQHC)
  • Logan, WV
National Provider Identifier
1366723975
Registry record updated Mar 8, 2023
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
Logan Wildcat Health Center
Practice address
1 Wildcat Way
Logan, WV 25601-3474
Phone
(304) 688-9949
Fax
(304) 688-9953
NPI assigned
Sep 9, 2011
Last updated
Mar 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2023

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

Authorized official

Name
Lisa Leach
Title
Ceo
Phone
(304) 824-5806

Specialties & licenses 1

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

Addresses

Primary practice location

1 Wildcat Way
Logan, WV 25601-3474

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
3810022652MedicaidWV
51D2055311OtherWVCLIA

Other names 1

  • Logan Wildcat Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111031000323 WV Part A Provider - Federally Qualified Health Center (FQHC) 6204821879 Practice locations: Logan, WV
O20121005000142 WV Part B Supplier - Clinic/Group Practice 6204821879 Receives reassigned benefits from 41 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chapmanvill, WV; Logan, WV; South Charleston, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366723975. Details of each certification follow.

Federally qualified health center certification: CCN 511975

Legal name
LINCOLN COUNTY PRIMARY CARE CENTER INC
Doing business as
LOGAN WILDCAT HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 31, 2011
Last certification
Oct 31, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 30, 1975 in WV
Enrollment address
1 Wildcat Way
Logan, WV 25601-8039

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D2055311Logan Wildcat Center for Health1 Wildcat Way, Logan, WV 25601Certificate of waiverMar 7, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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, 2017
Letitia Weaver-Scites Individual W-2 Managing EmployeeCredentialing Coordinator Apr 11, 2012
Lisa Leach Individual W-2 Managing EmployeeCeo Jun 12, 2018
David Boggess Individual Corporate DirectorBoard Member Jul 1, 2018
Ronald McGrady Individual W-2 Managing EmployeeAccountant Apr 6, 2016
Nancy Godby Individual Corporate DirectorBoard Member Jul 1, 2018
Julia a Barrett Individual Corporate Director Nov 1, 2011
W-2 Managing Employee Nov 1, 2011
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

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678233600000",
    "number": "1366723975",
    "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": "1 WILDCAT WAY",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256013474",
            "telephone_number": "304-688-9949",
            "fax_number": "304-688-9953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN COUNTY PRIMARY CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-09",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-08",
        "status": "A",
        "authorized_official_last_name": "LEACH",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CEO",
        "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": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810022652",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "51D2055311",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Logan Wildcat Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Logan Wildcat Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Logan, WV

Sources for this page

Verify at the official NPI Registry.