Provider Demographics
NPI:1669501144
Name:UNITED HOSPITAL CENTER
Entity type:Organization
Organization Name:UNITED HOSPITAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PLYWACZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:681-342-1000
Mailing Address - Street 1:PO BOX 775
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0775
Mailing Address - Country:US
Mailing Address - Phone:681-342-1000
Mailing Address - Fax:681-342-3125
Practice Address - Street 1:327 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:681-342-3100
Practice Address - Fax:681-342-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV107207RC0000X, 2086S0129X, 207Q00000X, 207ZP0105X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5100061OtherMEDICARE PTAN
WVC30572OtherRR GROUP NUMBER
CI9203OtherRR GROUP NUMBER
WV0001276003OtherMEDICAID PROVIDER NUMBER
WVCD9216OtherRR GROUP NUMBER
WVCD9217OtherRR GROUP NUMBER
CD9712OtherRR GROUP NUMBER
CD9712OtherRR GROUP NUMBER