# MOUNTAIN WEST DERM - BLACKHART PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Advanced Dermatology & Skin Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619517539
- **Authorized official:** BRET S BLACKHART MD (OWNER)
- **Authorized official phone:** (775) 336-3624

## Contact information

- **Practice address:** 1807 N HUTCHINSON RD, SPOKANE VALLEY, WA 99212-2444
- **Practice address phone:** (509) 456-7414
- **Practice address fax:** (509) 624-0764
- **Mailing address:** 1807 N HUTCHINSON RD, SPOKANE VALLEY, WA 99212-2444
- **Mailing address phone:** (509) 456-7414
- **Mailing address fax:** (509) 624-0764

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/08/2020
- **Last updated:** 01/08/2020