Organization
BLUE MOUNTAIN MEDICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALFRED ANTHONY TALL RRT, RPSGT (PRESIDENT)
(425) 673-3774
Entity
Organization
Contact information
Practice address
16515 MERIDIAN E, SUITE 203 B, PUYALLUP, WA 98375-6251
(253) 841-2700
Mailing address
7320 216TH ST SW, SUITE #30, EDMONDS, WA 98026-8006
(425) 673-3773
(425) 673-3776
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
LR00000073
WA
332BX2000X
Oxygen Equipment & Supplies (DME)
LR00000073
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
995195
—
WA
Enumeration date
12/18/2008
Last updated
12/18/2008
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