Organization
INTEGRATED HEALTH CARE PROVIDERS, INC.
Active
Other names
David Lee Cancer Center Lab
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY H. GOODE PT, MBA (PRESIDENT)
(304) 388-7783
Entity
Organization
Contact information
Practice address
3100 MACCORKLE AVE SE, SUITE 101, CHARLESTON, WV 25304-1223
(304) 388-8380
(304) 388-8388
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
—
0014092000
—
WV
Enumeration date
06/13/2007
Last updated
11/12/2007
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