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General NPI Number Information
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NPI Number | 1881031557
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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 | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 830 PENNSYLVANIA AVE SUITE 305
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City | CHARLESTON
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State | WV
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Zip | 25302-3302
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Country | US
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Telephone | 304-388-1770
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Fax | 304-388-1775
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Provider Business Mailing Address
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Address Line | PO BOX 1320
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City | SAINT ALBANS
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State | WV
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Zip | 25177-1320
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Country | US
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Telephone | 304-388-1724
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Fax | 304-388-1721
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. 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 | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number |
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License Number State |
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