Basic Information
| Provider Information | |||||||||
| NPI: | 1437885365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST MOUNTAIN HEALTH PHYSICIANS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 CAMPUS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405365100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1008 TAVERN RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | MARTINSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254012801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042635129 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2022 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | CHAMBERS | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER INSURANCE CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 5405360231 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EAST MOUNTAIN HEALTH PHYSICIANS, INC. | ||||||||
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| NPICertificationDate: | 07/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.