Basic Information
| Provider Information | |||||||||
| NPI: | 1457737660 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNITED HOSPITAL CENTER INC. | ||||||||
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| OtherOrganizationName: | UHC ONCOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 327 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263309006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6813421000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 AMALIA DR | ||||||||
| Address2: | |||||||||
| City: | BUCKHANNON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 262012239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044732000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2015 | ||||||||
| LastUpdateDate: | 08/11/2015 | ||||||||
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| AuthorizedOfficialLastName: | TILLMAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6813421620 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0200X | 107 | WV | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology |
No ID Information.