Organization
INTEGRATED HEALTH CARE PROVIDERS, INC.
Active
Other names
Facial Surgery Center II
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF GOODE PT, MBA (PRESIDENT)
(304) 388-7783
Entity
Organization
Contact information
Practice address
830 PENNSYLVANIA AVE STE 302, CHARLESTON, WV 25302-3390
(304) 388-2950
(304) 388-2951
Mailing address
415 MORRIS ST STE 304, CHARLESTON, WV 25301-1853
(304) 388-7782
(304) 388-7788
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810006521
—
WV
Enumeration date
08/01/2006
Last updated
11/15/2007
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