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General NPI Number Information
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NPI Number | 1699781294
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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 | 08/01/2006
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 830 PENNSYLVANIA AVE STE 302
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City | CHARLESTON
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State | WV
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Zip | 25302-3390
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Country | US
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Telephone | 304-388-2950
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Fax | 304-388-2951
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Provider Business Mailing Address
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Address Line | 415 MORRIS ST STE 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 | JEFF GOODE
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Credential | PT, MBA
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Telephone | 304-388-7783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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