Healthcare Provider Details

I. General information

NPI: 1689747255
Provider Name (Legal Business Name): UNITED PHYSICIANS CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ROUTE 98 W ST STE 401
NUTTER FORT WV
26301-4385
US

IV. Provider business mailing address

200 ROUTE 98 W ST STE 401
NUTTER FORT WV
26301-4385
US

V. Phone/Fax

Practice location:
  • Phone: 304-622-0704
  • Fax: 304-622-6109
Mailing address:
  • Phone: 304-622-0704
  • Fax: 304-622-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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