NPIMap

Organization Active NPI

United Physicians Care Inc

Doing business as Pennsboro Medical Center

  • Clinical Medical Laboratory
  • Pennsboro, WV
National Provider Identifier
1023186533
Registry record updated Jan 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
51D0710961 Issued in WV
Legal business name
UNITED PHYSICIANS CARE INC
Doing business as
Pennsboro Medical Center
Practice address
304 Masonic Ave
Pennsboro, WV 26415-1324
Phone
(304) 659-2986
Fax
(304) 659-2988
NPI assigned
Dec 1, 2006
Last updated
Jan 8, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John C Forester
Title
Chief Executive Officer
Phone
(304) 624-4655

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 51D0710961 WV Primary

Addresses

Primary practice location

304 Masonic Ave
Pennsboro, WV 26415-1324

Mailing address

686 S Pike St
Ste a
Shinnston, WV 26431-1043
Phone (304) 624-4655

Other identifiers 1

IdentifierTypeStateIssuer
6705061000MedicaidWV

Other names 1

  • Pennsboro Medical Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Accident Family Medicine24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1023186533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "686 S PIKE ST",
            "address_2": "STE A",
            "city": "SHINNSTON",
            "state": "WV",
            "postal_code": "264311043",
            "telephone_number": "304-624-4655",
            "fax_number": "304-624-3918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 MASONIC AVE",
            "city": "PENNSBORO",
            "state": "WV",
            "postal_code": "264151324",
            "telephone_number": "304-659-2986",
            "fax_number": "304-659-2988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED PHYSICIANS CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2009-01-08",
        "status": "A",
        "authorized_official_last_name": "FORESTER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "304-624-4655",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WV",
            "license": "51D0710961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6705061000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pennsboro Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pennsboro, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.