Provider Demographics
NPI:1659806602
Name:EAST MOUNTAIN HEALTH PHYSICIANS, INC.
Entity Type:Organization
Organization Name:EAST MOUNTAIN HEALTH PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
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 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2888
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0104
Practice Address - Street 1:100 OAK LEE DRIVE
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438
Practice Address - Country:US
Practice Address - Phone:540-536-2200
Practice Address - Fax:540-536-2205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST MOUNTAIN HEALTH PHYSICIANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-27
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care