Healthcare Provider Details

I. General information

NPI: 1235491176
Provider Name (Legal Business Name): INTEGRATED HEALTH CARE PROVIDERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE SUITE 301
CHARLESTON WV
25304-1223
US

IV. Provider business mailing address

PO BOX 1320
SAINT ALBANS WV
25177-1320
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-9190
  • Fax: 304-388-9195
Mailing address:
  • Phone: 304-388-1724
  • Fax: 304-388-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY H. GOODE
Title or Position: PRESIDENT
Credential: MBA
Phone: 304-388-7782