Provider Demographics
NPI:1578102760
Name:EAST MOUNTAIN HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:EAST MOUNTAIN HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-534-3435
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:INEZ
Mailing Address - State:KY
Mailing Address - Zip Code:41224-0389
Mailing Address - Country:US
Mailing Address - Phone:606-534-3435
Mailing Address - Fax:606-534-3436
Practice Address - Street 1:3165 BLACKLOG RD
Practice Address - Street 2:
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224-9113
Practice Address - Country:US
Practice Address - Phone:606-534-3435
Practice Address - Fax:606-534-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-05
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty