MEDICARE: UNITED HOSPITAL CENTER

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	207R00000X	Internal Medicine Physician	WV107	WV
2	207RR0500X	Rheumatology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001709473	OTHER	WV	BLUE CROSS PAY TO NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780767772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED HOSPITAL CENTER

Provider Business Mailing Address
First Line	:	527 MEDICAL PARK DR STE 400
Second Line	:
City	:	BRIDGEPORT
State	:	WV
Zip	:	26330-9010
Country	:	US
Telephone Number	:	681-342-3500
Fax Number	:	681-342-3507

Provider Business Practice Location Address
First Line	:	710 GENESIS BLVD
Second Line	:
City	:	BRIDGEPORT
State	:	WV
Zip	:	26330-9668
Country	:	US
Telephone Number	:	681-342-3490
Fax Number	:	681-342-3491

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL TILLMAN
Credential	:
Telephone Number	:	681-342-1000

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	11/01/2017

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Directions to “UNITED HOSPITAL CENTER ” Practice Location

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