# INTEGRATED HEALTH CARE PROVIDERS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Urology Center of Charleston
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639370034
- **Authorized official:** JEFF H. GOODE PT, MBA (ADMINISTRATIVE COORDINATOR)
- **Authorized official phone:** (304) 388-7783

## Contact information

- **Practice address:** 1201 WASHINGTON ST E, SUITE 105, CHARLESTON, WV 25301-1834
- **Practice address phone:** (304) 388-1965
- **Mailing address:** 415 MORRIS ST, SUITE 304, CHARLESTON, WV 25301-1842
- **Mailing address phone:** (304) 388-7783

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/31/2007
- **Last updated:** 08/22/2020