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General NPI Number Information
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NPI Number | 1225243785
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Entity Type | Organization
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Legal Business Name | INTEGRATED HEALTH CARE PROVIDERS, INC.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 3703 TEAYS VALLEY ROAD
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City | HURRICANE
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State | WV
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Zip | 25526-9645
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Country | US
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Telephone | 304-757-2273
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Fax | 304-760-9290
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Provider Business Mailing Address
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Address Line | 415 MORRIS STREET SUITE 304
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City | CHARLESTON
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State | WV
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Zip | 25301-1853
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Country | US
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Telephone | 304-388-7782
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Fax | 304-388-7788
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY H. GOODE
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Credential | MBA
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Telephone | 304-388-7782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 1664
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 1664
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License Number State | WV
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