NPIMap

Organization Active NPI

Lincoln County Primary Care Center, Inc.

Doing business as Duval Middle School Health Center

  • Federally Qualified Health Center (FQHC)
  • Griffithsville, WV
National Provider Identifier
1457541229
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
Duval Middle School Health Center
Practice address
5304 Straight Fork Road
Griffithsville, WV 25521-9504
Phone
(304) 524-9242
Fax
(304) 524-9241
NPI assigned
Jul 27, 2007
Last updated
Mar 8, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
LINCOLN COUNTY PRIMARY CARE CENTER, INC.As reported in NPPES

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

5304 Straight Fork Road
Griffithsville, WV 25521-9504

Mailing address

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

Other names 1

  • DUVAL MIDDLE SCHOOL HEALTH CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060908000461 WV Part A Provider - Federally Qualified Health Center (FQHC) 6204821879 1 other NPI on this enrollment
Practice locations: Griffithsville, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457541229. Details of each certification follow.

Federally qualified health center certification: CCN 511910

Legal name
LINCOLN COUNTY PRIMARY CARE CENTER INC
Doing business as
DUVAL MIDDLE SCHOOL HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 1, 2006
Last certification
Nov 1, 2006
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jun 30, 1975 in WV
Enrollment address
5304 Straight Fork
Griffithsville, WV 25521-9504

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 1

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

National Provider Directory

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

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 12

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

NameRoleSinceShare
Rebecca Farmer Individual Corporate DirectorBoard Member Jul 1, 2017
Jerry Lawson Individual Corporate DirectorBoard Member Jul 1, 2017
Letitia Weaver-Scites Individual W-2 Managing EmployeeCredentialing Coordinator Apr 11, 2012
Lisa Leach Individual Corporate DirectorCeo Jun 12, 2018
Operational/Managerial ControlCeo Mar 31, 2018
David Boggess Individual Corporate DirectorBoard Member Aug 1, 2018
Ollie Hunting Individual Corporate DirectorBoard Member Jul 1, 2014
Nancy Godby Individual Corporate DirectorBoard Member Jul 1, 2018
Kathryn Lambdin Individual Corporate DirectorBoard Member Jul 1, 2014
Tab Mathis Individual Corporate DirectorBoard Member Aug 1, 2019
Julia a Barrett Individual W-2 Managing EmployeeCfo/Delegated Official May 5, 1999
Courtney Cooper Individual Corporate DirectorBoard Member Jul 1, 2016
Mary Napier Individual Corporate DirectorBoard Member Jul 1, 2014

NPI Registry JSON

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

{
    "created_epoch": "1185494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678233600000",
    "number": "1457541229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 LYNN AVENUE",
            "city": "HAMLIN",
            "state": "WV",
            "postal_code": "255231138",
            "telephone_number": "304-824-5806",
            "fax_number": "304-824-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5304 STRAIGHT FORK ROAD",
            "city": "GRIFFITHSVILLE",
            "state": "WV",
            "postal_code": "255219504",
            "telephone_number": "304-524-9242",
            "fax_number": "304-524-9241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN COUNTY PRIMARY CARE CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LINCOLN COUNTY PRIMARY CARE CENTER, INC.",
        "enumeration_date": "2007-07-27",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DUVAL MIDDLE SCHOOL HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DUVAL MIDDLE SCHOOL HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Griffithsville, WV

Sources for this page

Verify at the official NPI Registry.