NPIMap

Organization Active NPI

Lincoln County Primary Care Center Inc

  • Federally Qualified Health Center (FQHC)
  • Wharton, WV
National Provider Identifier
1821790692
Registry record updated Mar 17, 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
Practice address
35767 Pond Fork Rd
Wharton, WV 25208-0341
Phone
(304) 247-6202
Fax
(304) 247-6203
NPI assigned
Mar 17, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 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

35767 Pond Fork Rd
Wharton, WV 25208-0341

Mailing address

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

Other names 1

  • Southern West Virginia Health System-Wharton Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230628002506 WV Part A Provider - Federally Qualified Health Center (FQHC) 6204821879 Practice locations: Wharton, WV
O20230910000152 WV Part B Supplier - Clinic/Group Practice 6204821879 Receives reassigned benefits from 21 practitioners
Practice locations: Wharton, WV

Federally qualified health center certification: CCN 581011

Legal name
LINCOLN COUNTY PRIMARY CARE CENTER INC
Doing business as
SOUTHERN WEST VIRGINIA HEALTH SYSTEM-WHARTON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 18, 2023
Last certification
May 18, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
35767 Pond Fork Rd
Wharton, WV 25208-0341

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

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
51D0016777Southern West Virginia Health System - Wharton35767 Pond Fork Road, Wharton, WV 25208Certificate of waiverAug 31, 2026

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
Audrey Robinette Individual Corporate DirectorBoard Member Mar 1, 2023
Rebecca Farmer Individual Corporate DirectorBoard Member Mar 1, 2023
Brian Vance Individual Corporate OfficerBoard Member Mar 1, 2023
Jerry Lawson Individual Corporate DirectorBoard Member Mar 1, 2023
Letitia Weaver-Scites Individual W-2 Managing EmployeeCredentialing Coordinator Apr 11, 2012
Lisa Leach Individual Corporate OfficerCeo Jun 12, 2018
David Boggess Individual Corporate DirectorBoard Member Mar 1, 2023
Ronald McGrady Individual Corporate OfficerCao Jul 1, 2018
Nancy Godby Individual Corporate DirectorBoard Member Mar 1, 2023
Priscilla Byrnside Individual Corporate DirectorBoard Member Mar 1, 2023
Lori Huffman Individual Corporate DirectorBoard Member Mar 1, 2023
Dana Snyder Individual Corporate DirectorBoard Member Mar 1, 2023

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1679011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679011200000",
    "number": "1821790692",
    "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": "35767 POND FORK RD",
            "city": "WHARTON",
            "state": "WV",
            "postal_code": "252080341",
            "telephone_number": "304-247-6202",
            "fax_number": "304-247-6203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN COUNTY PRIMARY CARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-17",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-16",
        "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": "Southern West Virginia Health System-Wharton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wharton, WV

Sources for this page

Verify at the official NPI Registry.