Healthcare Provider Details

I. General information

NPI: 1245308766
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: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 S PIKE ST
SHINNSTON WV
26431-1043
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 304-592-2100
  • Fax: 304-592-2102
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 Number51D0236494
License Number StateWV

VIII. Authorized Official

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