# BLUE MOUNTAIN REGENERATIVE MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205434370
- **Authorized official:** DR. JAMES EDWIN MCKINNEY III DC (OWNER)
- **Authorized official phone:** (717) 865-6183

## Contact information

- **Practice address:** 124 E MAIN ST., FREDERICKSBURG, PA 17026-0152
- **Practice address phone:** (717) 507-4469
- **Mailing address:** PO BOX 152, FREDERICKSBURG, PA 17026-0152
- **Mailing address phone:** (717) 507-4469

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 10/12/2020
- **Last updated:** 10/15/2020