# BLUE MOUNTAIN CLINIC, INC.

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

## Provider details

- **NPI number:** 1407987548
- **Authorized official:** MS. ANNIE HANSEN (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (406) 721-1646

## Contact information

- **Practice address:** 610 N CALIFORNIA ST, MISSOULA, MT 59802-3950
- **Practice address phone:** (406) 721-1946
- **Practice address fax:** (406) 543-9890
- **Mailing address:** 610 N CALIFORNIA ST, MISSOULA, MT 59802-3950
- **Mailing address phone:** (406) 721-1946
- **Mailing address fax:** (406) 543-9890

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 9607 | MT | Yes |

## Other

- **Enumeration date:** 03/08/2007
- **Last updated:** 05/24/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0218478 | — | MT |