# BLACK STONE HEALTH PC

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

## Provider details

- **NPI number:** 1457764961
- **Authorized official:** MARC MUSSON DO (OWNER)
- **Authorized official phone:** (513) 658-8605

## Contact information

- **Practice address:** 2358 NW KINGS BLVD, SUITE 100, CORVALLIS, OR 97330
- **Practice address phone:** (541) 368-5986
- **Practice address fax:** (866) 624-8745
- **Mailing address:** 2358 NW KINGS BLVD \#100, CORVALLIS, OR 97330-3925

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/03/2014
- **Last updated:** 04/27/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 500683153 | — | OR |