Organization
INTEGRATED HEALTH CARE PROVIDERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY H. GOODE MBA, CMPE, FACHE (PRESIDENT)
(304) 388-7782
Entity
Organization
Contact information
Practice address
415 MORRIS ST, SUITE 304, CHARLESTON, WV 25301-1842
(304) 388-7782
(304) 388-7788
Mailing address
415 MORRIS ST, SUITE 304, CHARLESTON, WV 25301-1842
(304) 388-7782
(304) 388-7788
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207VE0102X
Reproductive Endocrinology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
208200000X
Plastic Surgery Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010400000
—
WV
01
—
51D2006880
CLIA NUMBER
—
Enumeration date
07/19/2006
Last updated
01/08/2014
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