Healthcare Provider Details

I. General information

NPI: 1194269589
Provider Name (Legal Business Name): UNITED HOSPITAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 MIDDLETOWN RD STE 1
WHITE HALL WV
26554-8254
US

IV. Provider business mailing address

527 MEDICAL PARK DR STE 400
BRIDGEPORT WV
26330-9010
US

V. Phone/Fax

Practice location:
  • Phone: 304-363-6600
  • Fax: 304-333-5201
Mailing address:
  • Phone: 681-342-3500
  • Fax: 681-342-3507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL TILLMAN
Title or Position: CEO
Credential:
Phone: 681-342-1000