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Organization
BLUE MOUNTAIN CLINIC, INC.
Active
Organization
BLUE MOUNTAIN CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANNIE HANSEN (EXECUTIVE DIRECTOR)
(406) 721-1646
Entity
Organization
Contact information
Practice address
610 N CALIFORNIA ST, MISSOULA, MT 59802-3950
(406) 721-1946
(406) 543-9890
Mailing address
610 N CALIFORNIA ST, MISSOULA, MT 59802-3950
(406) 721-1946
(406) 543-9890
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9607
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0218478
—
MT
Enumeration date
03/08/2007
Last updated
05/24/2016
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