Lincoln County Primary Care Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Griffithsville, WV
NPI 1457541229 · NPPES record last updated Mar 8, 2023
Key facts
- NPI
- 1457541229
- 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
- 5304 Straight Fork Road
Griffithsville, WV 25521-9504 - Phone
- (304) 524-9242
- Fax
- (304) 524-9241
- NPI assigned
- Jul 27, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- LINCOLN COUNTY PRIMARY CARE CENTER, INC.
Authorized official
- Name
- Lisa Leach
- Title
- Ceo
- Phone
- (304) 824-5806
Other NPIs on the same Medicare enrollment 1
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 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
- Corporation · Non-profit
- Incorporated
- Jun 30, 1975 in WV
- Enrollment address
- 5304 Straight Fork
Griffithsville, WV 25521-9504
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Rebecca Farmer |
Corporate Director |
Jul 1, 2017 | |
| Jerry Lawson |
Corporate Director |
Jul 1, 2017 | |
| Letitia Weaver-Scites |
W-2 Managing Employee |
Apr 11, 2012 | |
| Lisa Leach |
Corporate Director |
Jun 12, 2018 | |
| Operational/Managerial Control |
Mar 31, 2018 | ||
| David Boggess |
Corporate Director |
Aug 1, 2018 | |
| Ollie Hunting |
Corporate Director |
Jul 1, 2014 | |
| Nancy Godby |
Corporate Director |
Jul 1, 2018 | |
| Kathryn Lambdin |
Corporate Director |
Jul 1, 2014 | |
| Tab Mathis |
Corporate Director |
Aug 1, 2019 | |
| Julia a Barrett |
W-2 Managing Employee |
May 5, 1999 | |
| Courtney Cooper |
Corporate Director |
Jul 1, 2016 | |
| Mary Napier |
Corporate Director |
Jul 1, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060908000461 | WV | Part a Provider - Federally Qualified Health Center (FQHC) | 6204821879 |
1 other NPI on this enrollment Practice locations: Griffithsville, WV |
National Provider Directory
- Tax ID family
- Man Rexcellence Program
- Part of
- Man Rexcellence Program
Locations
5304 Straight Frk
Griffithsville, WV 25521
Phone (304) 524-9241
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CA9760 | Other | WV | MEDICARE RR |
| 3810011411 | Medicaid | WV |
Other names
- DUVAL MIDDLE SCHOOL HEALTH CENTER
Other providers in Griffithsville, WV
- Todd Flowers
- Amanda Holdren
- Shayla Rashell Holley
- Jennifer Jarrell
- Leslie Renee Jordan
- Alma Hester Linville
- Lisa McClure
- Latonya Stowers
- Andrea Sue Woodrum
All providers in Griffithsville, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.