| Organization Name: | LEWIS COUNTY PRIMARY CARE CENTER, INC |
| NPI Number: | 1043336506 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRY UGRIN (CEO) |
| Mailing Address: | 211 Ky 59 Vanceburg |
| State: | KY US |
| Postal Code: | 411797647 |
| Phone Number: | 6067963029 |
| Fax Number: | 6067966221 |
| NPI Enumeration Date: | 03/22/2007 |
| NPI Last Update Date: | 01/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 100989 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |