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General NPI Number Information
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NPI Number | 1619176302
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Entity Type | Organization
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Legal Business Name | UNITED PHYSICIANS CARE INC
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 1511 JOHNSON AVE STE 104
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1016
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Country | US
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Telephone | 304-848-0702
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Fax | 304-848-0705
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Provider Business Mailing Address
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Address Line | 686 SOUTH PIKE ST STE A
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City | SHINNSTON
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State | WV
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Zip | 26431-1043
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Country | US
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Telephone | 304-624-4655
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Fax | 304-624-3918
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JOHN C FORESTER
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Credential |
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Telephone | 304-624-4655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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