Healthcare Provider Details

I. General information

NPI: 1386712347
Provider Name (Legal Business Name): UNITED PHYSICIANS CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E PEARL ST
HARRISVILLE WV
26362-9759
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 304-643-2957
  • Fax: 304-643-2958
Mailing address:
  • Phone: 304-624-4655
  • Fax: 304-624-3918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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