Basic Information
| Provider Information | |||||||||
| NPI: | 1366796013 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY HEALTHCARE PHYSICIANS, INC. | ||||||||
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| OtherOrganizationName: | HARPERS FERRY FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 FOUNDATION WAY | ||||||||
| Address2: | |||||||||
| City: | MARTINSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254019000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042649202 | ||||||||
| FaxNumber: | 3042649042 | ||||||||
| Practice Location | |||||||||
| Address1: | 171 TAYLOR ST | ||||||||
| Address2: | |||||||||
| City: | HARPERS FERRY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254253641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045356343 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2012 | ||||||||
| LastUpdateDate: | 07/28/2014 | ||||||||
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| AuthorizedOfficialLastName: | NAU | ||||||||
| AuthorizedOfficialFirstName: | KONRAD | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3042649202 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 183500000X | N | 193200000X MULTI-SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist | 207RR0500X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 261QR1300X | WV | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.