Basic Information
| Provider Information | |||||||||
| NPI: | 1033304316 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED HEALTH PROFESSIONALS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 PEYTON ST | ||||||||
| Address2: | |||||||||
| City: | BARBOURSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046972035 | ||||||||
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| Practice Location | |||||||||
| Address1: | 143 PEYTON ST | ||||||||
| Address2: | |||||||||
| City: | BARBOURSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255040000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046972035 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 11/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | CHAMBERLAIN | ||||||||
| AuthorizedOfficialFirstName: | ALLAN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3046972035 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | WV | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 0037674000 | 05 | WV | MEDICAID |