Healthcare Provider Details

I. General information

NPI: 1396284089
Provider Name (Legal Business Name): EAST MOUNTAIN HEALTH PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 T J JACKSON DR SUITE B
FALLING WATERS WV
25419-4698
US

IV. Provider business mailing address

220 CAMPUS BLVD SUITE 200
WINCHESTER VA
22601
US

V. Phone/Fax

Practice location:
  • Phone: 304-350-3201
  • Fax: 304-350-3240
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateWV

VIII. Authorized Official

Name: DR. GERALD J BECHAMPS
Title or Position: CEO
Credential: MD
Phone: 304-822-4933