Provider Demographics
NPI:1134305089
Name:INTEGRATED HEALTH CARE PROVIDERS, INC.
Entity Type:Organization
Organization Name:INTEGRATED HEALTH CARE PROVIDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:304-388-7784
Mailing Address - Street 1:415 MORRIS ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1842
Mailing Address - Country:US
Mailing Address - Phone:304-388-7783
Mailing Address - Fax:304-388-7788
Practice Address - Street 1:500 DONNALLY ST
Practice Address - Street 2:STE 100
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1648
Practice Address - Country:US
Practice Address - Phone:304-346-0439
Practice Address - Fax:304-346-6904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9286133Medicare PIN