Provider Demographics
NPI:1144224775
Name:UNIVERSITY PHYSICIANS & SURGEONS, INC.
Entity Type:Organization
Organization Name:UNIVERSITY PHYSICIANS & SURGEONS, INC.
Other - Org Name:UNIVERSITY PATHOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-691-1602
Mailing Address - Street 1:1001 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-697-4497
Mailing Address - Fax:304-523-9470
Practice Address - Street 1:1001 10TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3316
Practice Address - Country:US
Practice Address - Phone:304-697-4497
Practice Address - Fax:304-523-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZP0102X
WV291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Not Answered291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65929598Medicaid
OH2045334Medicaid
WV0010855000Medicaid
WV9148242Medicare ID - Type Unspecified