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General NPI Number Information
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NPI Number | 1184940132
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Entity Type | Organization
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Legal Business Name | UNITED HOSPITAL CENTER
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 527 MEDICAL PARK DR STE 402
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City | BRIDGEPORT
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State | WV
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Zip | 26330-9010
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Country | US
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Telephone | 681-342-3690
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Fax |
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Provider Business Mailing Address
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Address Line | 527 MEDICAL PARK DR STE 402
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City | BRIDGEPORT
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State | WV
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Zip | 26330-9010
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Country | US
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Telephone | 681-342-3690
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL TILLMAN
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Credential |
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Telephone | 681-342-1620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 107
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License Number State | WV
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