# BLUE MOUNTAIN FAMILY HEALTH PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blue Mountain Family Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679649248
- **Authorized official:** KEVIN JAMES BLACK (ADMINISTRATOR)
- **Authorized official phone:** (509) 751-5500

## Contact information

- **Practice address:** 1268 BRIDGE ST, CLARKSTON, WA 99403-2219
- **Practice address phone:** (509) 751-5500
- **Practice address fax:** (509) 751-1059
- **Mailing address:** 1268 BRIDGE ST, CLARKSTON, WA 99403-2219
- **Mailing address phone:** (509) 751-5500
- **Mailing address fax:** (509) 751-1059

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD00045393 | WA | Yes |

## Other

- **Enumeration date:** 11/27/2006
- **Last updated:** 05/21/2024