Healthcare Provider Details

I. General information

NPI: 1235642273
Provider Name (Legal Business Name): UNITED HOSPITAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 MEDICAL PARK DR
BRIDGEPORT WV
26330-9006
US

IV. Provider business mailing address

327 MEDICAL PARK DR
BRIDGEPORT WV
26330-9006
US

V. Phone/Fax

Practice location:
  • Phone: 681-342-1000
  • Fax:
Mailing address:
  • Phone: 304-285-7101
  • Fax: 304-293-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL TILLMAN
Title or Position: CEO
Credential:
Phone: 681-342-1600