Organization Name: | LEWIS COUNTY PRIMARY CARE CENTER, INC. |
NPI Number: | 1457303802 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JERRY G UGRIN (CEO) |
Mailing Address: | 211 Ky 59 Vanceburg |
State: | KY US |
Postal Code: | 411799719 |
Phone Number: | 6067963029 |
Fax Number: | 6067966221 |
NPI Enumeration Date: | 05/16/2006 |
NPI Last Update Date: | 10/16/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | 700041 |
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: |