Basic Information
| Provider Information | |||||||||
| NPI: | 1376590786 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED HOSPITAL CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ANESTHESIA DEPARTMENT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6209 | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260030714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042332455 | ||||||||
| FaxNumber: | 3042336073 | ||||||||
| Practice Location | |||||||||
| Address1: | 327 MEDICAL PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6813421000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 04/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | COFFMAN | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6813421000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | WV25724B | 01 | WV | HEALTH PLAN | OTHER | 229645 | 01 | WV | CARELINK | OTHER | 001709474 | 01 | WV | MOUNTAIN STATE BCBS | OTHER | 0001276006 | 05 | WV | MEDICAID |