Provider Demographics
NPI:1972770931
Name:UHA, WVU URGENT CARE LAB
Entity Type:Organization
Organization Name:UHA, WVU URGENT CARE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-293-5033
Mailing Address - Street 1:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0897
Mailing Address - Country:US
Mailing Address - Phone:304-293-7401
Mailing Address - Fax:304-293-6963
Practice Address - Street 1:1075 VAN VOORHIS RD
Practice Address - Street 2:SUITE 100 SUNCREST EXECUTIVE PLAZA
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3586
Practice Address - Country:US
Practice Address - Phone:304-599-2273
Practice Address - Fax:304-293-6963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV51D1072489291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0011526000Medicaid
WV9121131Medicare PIN