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Organization
BLACK STONE HEALTH PC
Active
Organization
BLACK STONE HEALTH PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC MUSSON DO (OWNER)
(513) 658-8605
Entity
Organization
Contact information
Practice address
2358 NW KINGS BLVD, SUITE 100, CORVALLIS, OR 97330
(541) 368-5986
(866) 624-8745
Mailing address
2358 NW KINGS BLVD #100, CORVALLIS, OR 97330-3925
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500683153
—
OR
Enumeration date
06/03/2014
Last updated
04/27/2016
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