Healthcare Provider Details

I. General information

NPI: 1114460797
Provider Name (Legal Business Name): EAST MOUNTAIN HEALTH PHYSICIANS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 SUSHRUTA DR SUITE D
MARTINSBURG WV
25401-8802
US

IV. Provider business mailing address

220 CAMPUS BLVD SUITE 200
WINCHESTER VA
22601
US

V. Phone/Fax

Practice location:
  • Phone: 304-262-2538
  • Fax: 304-262-2583
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateWV

VIII. Authorized Official

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