1396284089 NPI number — EAST MOUNTAIN HEALTH PHYSICIANS INC

Table of content: (NPI 1396284089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396284089 NPI number — EAST MOUNTAIN HEALTH PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST MOUNTAIN HEALTH PHYSICIANS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396284089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 CAMPUS BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-536-5100
Provider Business Mailing Address Fax Number:
540-536-0104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1179 T J JACKSON DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FALLING WATERS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25419-4698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-350-3201
Provider Business Practice Location Address Fax Number:
304-350-3240
Provider Enumeration Date:
02/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BECHAMPS
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
304-822-4933

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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