1841711512 NPI number — EAST MOUNTAIN HEALTH PHYSICIANS, INC.

Table of content: (NPI 1841711512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841711512 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:
1841711512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37818
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21297-7818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-536-3386
Provider Business Mailing Address Fax Number:
540-536-3263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 OAK LEE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANSON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-930-0001
Provider Business Practice Location Address Fax Number:
681-252-1843
Provider Enumeration Date:
07/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
NEVADA
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
540-536-0103

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X , 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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