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Organization

INTEGRATED HEALTH CARE PROVIDERS, INC.

Active
Other names
Urology Center Memorial Lab
Organization subpart
No

Provider details

NPI number
Authorized official
JEFFREY H. GOODE MBA (PRESIDENT)
(304) 388-7782
Entity
Organization

Contact information

Practice address
3100 MACCORKLE AVE SE, SUITE 408, CHARLESTON, WV 25304-1223
(304) 388-5280
(304) 388-5291
Mailing address
415 MORRIS ST, SUITE 304, CHARLESTON, WV 25301-1842
(304) 388-7782
(304) 388-7788

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
51D2006880
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
51D2006880
CLIA NUMBER
WV
Enumeration date
05/11/2010
Last updated
09/07/2010
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