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General NPI Number Information
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NPI Number | 1477067577
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Entity Type | Organization
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Legal Business Name | EAST MOUNTAIN HEALTH PHYSICIANS, INC.
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 12/12/2018
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Provider Practice Location Address
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Address Line | 1008 TAVERN RD STE 201
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City | MARTINSBURG
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State | WV
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Zip | 25401-2859
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Country | US
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Telephone | 304-264-4433
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Fax |
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Provider Business Mailing Address
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Address Line | 220 CAMPUS BLVD STE 200
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City | WINCHESTER
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State | VA
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Zip | 22601-2889
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Country | US
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Telephone | 540-536-5100
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Fax | 540-536-0235
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | RENEE NEVADA JOHNSON
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Credential |
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Telephone | 540-536-0103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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