NPIMap

Organization Active NPI

Lincoln County Primary Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Man, WV
National Provider Identifier
1689997678
Registry record updated May 8, 2020
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.
Practice address
600 E McDonald Ave
Man, WV 25635-1023
Phone
(304) 583-8585
Fax
(304) 583-0129
NPI assigned
Mar 5, 2010
Last updated
May 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2020

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

600 E McDonald Ave
Man, WV 25635-1023

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
3810018665MedicaidWV

Other names 1

  • Southern West Virginia Health System-Man Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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
O20100524000695 WV Part A Provider - Federally Qualified Health Center (FQHC) 6204821879 Practice locations: Man, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689997678. Details of each certification follow.

Federally qualified health center certification: CCN 511952

Legal name
LINCOLN COUNTY PRIMARY CARE CENTER INC
Doing business as
SOUTHERN WEST VIRGINIA HEALTH SYSTEM-MAN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 6, 2010
Last certification
Jul 6, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 30, 1975 in WV
Enrollment address
600 E McDonald Ave
Man, WV 25635-1023

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 7

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

National Provider Directory

National Provider Directory

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 Employee Apr 11, 2012
Lisa Leach Individual Operational/Managerial ControlCeo Mar 31, 2018
David Boggess Individual Corporate DirectorBoard Member Jul 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 Employee May 5, 1999
Courtney Cooper Individual Corporate DirectorBoard Member Jul 1, 2016
Mary Napier Individual Corporate DirectorBoard Member Jul 1, 2014

Practitioners & affiliated clinicians

Practitioners 48

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.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1267747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588896000000",
    "number": "1689997678",
    "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": "304-824-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E MCDONALD AVE",
            "city": "MAN",
            "state": "WV",
            "postal_code": "256351023",
            "telephone_number": "304-583-8585",
            "fax_number": "304-583-0129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN COUNTY PRIMARY CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-05",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "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": "3810018665",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern West Virginia Health System-Man",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Southern West Virginia Health System-Man",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Man, WV

Sources for this page

Verify at the official NPI Registry.