NPIMap

Organization Active NPI

United Physicians Care Inc

Doing business as Elk Memorial Clinic

  • Clinical Medical Laboratory
  • Gassaway, WV
National Provider Identifier
1235207903
Registry record updated Jan 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
51D0881066 Issued in WV
Legal business name
UNITED PHYSICIANS CARE INC
Doing business as
Elk Memorial Clinic
Practice address
626 Elk St
Gassaway, WV 26624-1136
Phone
(304) 364-2401
Fax
(304) 364-2441
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 Foreser
Title
Executive Director
Phone
(304) 624-4655

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 51D0881066 WV Primary

Addresses

Primary practice location

626 Elk St
Gassaway, WV 26624-1136

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0008279001MedicaidWV

Other names 1

  • Elk Memorial Clinic 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": "1235207903",
    "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": "626 ELK ST",
            "city": "GASSAWAY",
            "state": "WV",
            "postal_code": "266241136",
            "telephone_number": "304-364-2401",
            "fax_number": "304-364-2441"
        }
    ],
    "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": "FORESER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "304-624-4655",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WV",
            "license": "51D0881066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0008279001",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elk Memorial Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gassaway, 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.