Provider Demographics
NPI:1073024923
Name:EAST MOUNTAIN HEALTH PHYSICIANS INC
Entity type:Organization
Organization Name:EAST MOUNTAIN HEALTH PHYSICIANS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR INSURANCE CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:NEVADA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-0103
Mailing Address - Street 1:220 CAMPUS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2889
Mailing Address - Country:US
Mailing Address - Phone:540-536-0231
Mailing Address - Fax:
Practice Address - Street 1:710 SOMERSET BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-4998
Practice Address - Country:US
Practice Address - Phone:304-724-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST MOUNTAIN HEALTH PHYSICIANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-18
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty