Healthcare Provider Details

I. General information

NPI: 1285702795
Provider Name (Legal Business Name): UNITED PHYSICIANS CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 4 BOX 315
PHILIPPI WV
26416-9591
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 304-457-5744
  • Fax: 304-457-5758
Mailing address:
  • Phone: 304-624-4655
  • Fax: 304-624-3918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number51D0867171
License Number StateWV

VIII. Authorized Official

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