Provider Demographics
NPI:1114460797
Name:EAST MOUNTAIN HEALTH PHYSICIANS INC.
Entity Type:Organization
Organization Name:EAST MOUNTAIN HEALTH PHYSICIANS INC.
Other - Org Name:VALLEY HEALTH FAMILY MEDICINE - BRIARWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BECHAMPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-822-4933
Mailing Address - Street 1:220 CAMPUS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0104
Practice Address - Street 1:1004 SUSHRUTA DR
Practice Address - Street 2:SUITE D
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8802
Practice Address - Country:US
Practice Address - Phone:304-262-2538
Practice Address - Fax:304-262-2583
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST MOUNTAIN HEALTH PHYSICIANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-30
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty