Healthcare Provider Details

I. General information

NPI: 1932621919
Provider Name (Legal Business Name): EAST MOUNTAIN HEALTH PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 TAVERN RD STE 301
MARTINSBURG WV
25401-2801
US

IV. Provider business mailing address

220 CAMPUS BLVD SUITE 200
WINCHESTER VA
22601
US

V. Phone/Fax

Practice location:
  • Phone: 681-247-1070
  • Fax: 681-247-1071
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL CHAMBERS
Title or Position: MANAGER INSURANCE CREDENTIALING
Credential:
Phone: 540-536-0231