Lincoln County Primary Care Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Gilbert, WV
NPI 1942523931 · NPPES record last updated Feb 28, 2025
Key facts
- NPI
- 1942523931
- 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
- 621 Larry Joe Harless Drive
Gilbert, WV 25621-1842 - Phone
- (304) 664-6270
- Fax
- (304) 664-6272
- NPI assigned
- Mar 5, 2010
- Organization subpart
- No
Authorized official
- Name
- Lisa Leach
- Title
- Ceo
- Phone
- (304) 824-5806
Other NPIs on the same Medicare enrollment 7
Other NPIs with the same Medicare PAC ID 24
Practitioners 55
-
Lisa Adkins, FNP
-
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
-
Michelle Justice, NP
-
Melissa Rena Kijewski, D.O.
-
Chassity Kirk, APRN-FNP-BC
-
George L McKay, MD
-
Mary Jane Phipps, FNP
-
Alyssa Michele Skeens, FNP-BC
-
Candice Stacy, FNP-BC
-
Mara Wright Sutphin, P.A.-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Federally qualified health center certification: CCN 511953
- Legal name
- LINCOLN COUNTY PRIMARY CARE CENTER INC
- Doing business as
- SOUTHERN WEST VIRGINIA HEALTH SYSTEMS-GILBERT
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 19, 2010
- Last certification
- Oct 19, 2010
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 30, 1975 in WV
- Enrollment address
- 621 Larry Joe Harless Drive
Gilbert, WV 25621
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 | Oct 12, 2012 | |
| Lisa Leach |
Operational/Managerial Control |
Mar 31, 2018 | |
| David Boggess |
Corporate Director |
Jul 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 |
Corporate Director | May 5, 1999 | |
| 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 |
|---|---|---|---|---|
| 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 |
| O20100612000201 | WV | Part a Provider - Federally Qualified Health Center (FQHC) | 6204821879 | Practice locations: Gilbert, WV |
National Provider Directory
Locations
621 Larry Joe Harless Dr
Ste 205
Gilbert, WV 25621
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
621 Larry Joe Harless Drive
Gilbert, WV 25621-1842
Mailing address
7400 Lynn Ave
Hamlin, WV 25523-1138
Phone (304) 824-5806
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810019387 | Medicaid | WV |
Other names
- Southern West Virignia Health System-Gilbert
Other providers in Gilbert, WV
- Integrated Health Care Providers, Inc.
- Savanna Nicole Johnson
- Christopher Patrick Kelly
- Brenda Jo Killen
- Lincoln County Primary Care Center Inc
- Cassidy Lowe
- Misty Dawn May
- Mountaineer Family Medicine, Inc.
- Dustin Lee Paige
- Mary Jane Phipps
All providers in Gilbert, 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 Feb 28, 2025. 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.