1770533564 NPI number — UNIVERSITY PHYSICIANS & SURGEONS, INC.

Table of content: (NPI 1770533564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770533564 NPI number — UNIVERSITY PHYSICIANS & SURGEONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY PHYSICIANS & SURGEONS, 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:
Provider Other Organization Name Type Code:
6
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:
1770533564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
SUITE 2500
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-3656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-691-1200
Provider Business Mailing Address Fax Number:
304-691-1287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 HOSPITAL DRIVE, KRUGER MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-792-1847
Provider Business Practice Location Address Fax Number:
304-792-1849
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOVINS
Authorized Official First Name:
PAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
304-691-1640

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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