Organization
LINCOLN COUNTY PRIMARY CARE CENTER, INC.
Active
Other names
Logan Wildcat Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
LISA LEACH (CEO)
(304) 824-5806
Entity
Organization
Contact information
Practice address
1 WILDCAT WAY, LOGAN, WV 25601-3474
(304) 688-9949
(304) 688-9953
Mailing address
7400 LYNN AVE, HAMLIN, WV 25523-1138
(304) 824-5806
(304) 824-5804
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810022652
—
WV
01
—
51D2055311
CLIA
WV
Enumeration date
09/09/2011
Last updated
03/08/2023
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