1699781294 NPI number — INTEGRATED HEALTH CARE PROVIDERS, INC.

Table of content: (NPI 1699781294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699781294 NPI number — INTEGRATED HEALTH CARE PROVIDERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED HEALTH CARE PROVIDERS, 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:
FACIAL SURGERY CENTER II
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:
1699781294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 MORRIS ST STE 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25301-1853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-388-7782
Provider Business Mailing Address Fax Number:
304-388-7788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 PENNSYLVANIA AVE STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25302-3390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-388-2950
Provider Business Practice Location Address Fax Number:
304-388-2951
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOODE
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-388-7783

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810006521 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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