MEDICARE: UNIVERSITY PHYSICIANS & SURGEONS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1396793592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY PHYSICIANS & SURGEONS, INC.

Provider Business Mailing Address
First Line	:	1600 MEDICAL CENTER DR
Second Line	:	SUITE 2500
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3656
Country	:	US
Telephone Number	:	304-691-1200
Fax Number	:	304-691-1287

Provider Business Practice Location Address
First Line	:	2561 3RD AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25703-1642
Country	:	US
Telephone Number	:	304-525-9131
Fax Number	:	304-525-2957

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	PAM LOVINS
Credential	:	CPCS
Telephone Number	:	304-691-1640

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/22/2020

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