Organization
INTEGRATED HEALTH CARE PROVIDERS, INC.
Active
Other names
Ryan White Program Grant
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY H. GOODE PT, MBA (PRESIDENT)
(304) 388-7784
Entity
Organization
Contact information
Practice address
3200 MACCORKLE AVE SE, OUTPATIENT CARE CLINIC, CHARLESTON, WV 25304-1227
(304) 388-8909
Mailing address
415 MORRIS ST, SUITE 304, CHARLESTON, WV 25301-1842
(304) 388-7783
(304) 388-7788
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810009608
—
WV
Enumeration date
07/20/2007
Last updated
11/15/2007
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