1093956104 NPI number — INTEGRATED HEALTH CARE PROVIDERS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093956104 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:
Provider Other Organization Name Type Code:
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:
1093956104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 MORRIS ST
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25301-1842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
394-388-7784
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
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25302-3302
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:
03/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GOODE
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-388-7784

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  51D1005617 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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