Organization
INTEGRATED HEALTH CARE PROVIDERS, INC.
Active
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
208800000X
Urology Physician
Primary
19638
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51D2006880
CLIA NUMBER
—
Enumeration date
04/27/2010
Last updated
09/07/2010
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