# BLUE MOUNTAIN MEDICAL CLINIC, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LIFE & HEALTH SERVICES
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1023538758
- **Legal business name:** LIFE & HEALTH SERVICES
- **Authorized official:** TINA POORE (OFFICE MANAGER)
- **Authorized official phone:** (606) 242-2519

## Contact information

- **Practice address:** 1814 CUMBERLAND AVE, MIDDLESBORO, KY 40965
- **Practice address phone:** (606) 242-2519
- **Practice address fax:** (606) 242-2520
- **Mailing address:** 1814 CUMBERLAND AVE, MIDDLESBORO, KY 40965-1229
- **Mailing address phone:** (606) 242-2519
- **Mailing address fax:** (606) 242-2520

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | KY | Yes |

## Other

- **Enumeration date:** 06/23/2017
- **Last updated:** 06/26/2018