Healthcare Provider Details

I. General information

NPI: 1801140579
Provider Name (Legal Business Name): UNIVERSITY HEALTHCARE PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 SOMERSET BLVD STE 102
CHARLES TOWN WV
25414
US

IV. Provider business mailing address

2500 FOUNDATION WAY
MARTINSBURG WV
25401-9000
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-2273
  • Fax: 304-724-0053
Mailing address:
  • Phone: 304-264-9202
  • Fax: 304-264-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KONRAD C. NAU
Title or Position: CEO
Credential: M.D.
Phone: 304-264-9202