Organization
INTEGRATED HEALTH CARE PROVIDERS, INC.
Active
Other names
Facial Surgery Center I Lab
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFERY H. GOODE PT, MBA (PRESIDENT)
(304) 388-7783
Entity
Organization
Contact information
Practice address
415 MORRIS ST STE 309, CHARLESTON, WV 25301-1853
(304) 388-3290
(304) 388-3186
Mailing address
415 MORRIS ST STE 304, CHARLESTON, WV 25301-1853
(304) 388-7783
(304) 388-7788
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6702025-003
—
WV
Enumeration date
06/13/2007
Last updated
11/15/2007
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