1902206857 NPI number — LEWIS COUNTY PRIMARY CARE CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902206857 NPI number — LEWIS COUNTY PRIMARY CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIS COUNTY PRIMARY CARE CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRIMARYPLUS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902206857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCEBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41179-0550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-796-3029
Provider Business Mailing Address Fax Number:
606-796-6221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
432 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-7693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-324-7184
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
UGRIN
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
606-796-3029

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  700041 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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