Provider Demographics
NPI:1134101660
Name:UNITED HOSPITAL CENTER INC
Entity Type:Organization
Organization Name:UNITED HOSPITAL CENTER INC
Other - Org Name:UHC FAMILY MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CORPORATE COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:681-342-1610
Mailing Address - Street 1:527 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9010
Mailing Address - Country:US
Mailing Address - Phone:681-342-3600
Mailing Address - Fax:681-342-3625
Practice Address - Street 1:527 MEDICAL PARK DR
Practice Address - Street 2:SUITE 500
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9010
Practice Address - Country:US
Practice Address - Phone:681-342-3600
Practice Address - Fax:681-342-3625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0007392000Medicaid
WV001709473OtherBLUE CROSSBLUESHIELDGROUP
WV0007392002Medicaid
WVCI9203OtherRAILROAD MEDICARE GROUP
WV0007392002Medicaid
WV=========007OtherTRICARE GROUP NUMBER