Healthcare Provider Details

I. General information

NPI: 1619176302
Provider Name (Legal Business Name): UNITED PHYSICIANS CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 JOHNSON AVE STE 104
BRIDGEPORT WV
26330-1016
US

IV. Provider business mailing address

686 SOUTH PIKE ST STE A
SHINNSTON WV
26431-1043
US

V. Phone/Fax

Practice location:
  • Phone: 304-848-0702
  • Fax: 304-848-0705
Mailing address:
  • Phone: 304-624-4655
  • Fax: 304-624-3918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN C FORESTER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 304-624-4655