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Organization
BLUE MOUNTAIN REGENERATIVE MEDICINE PLLC
Active
Organization
BLUE MOUNTAIN REGENERATIVE MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES EDWIN MCKINNEY III DC (OWNER)
(717) 865-6183
Entity
Organization
Contact information
Practice address
124 E MAIN ST., FREDERICKSBURG, PA 17026-0152
(717) 507-4469
Mailing address
PO BOX 152, FREDERICKSBURG, PA 17026-0152
(717) 507-4469
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
—
NULL
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
10/12/2020
Last updated
10/15/2020
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