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
1530 S UNION AVE, SUITE 10, TACOMA, WA 98405-1954
(253) 759-2700
(253) 759-9986
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
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
LR00000073
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
995195
—
WA
Enumeration date
05/30/2008
Last updated
06/19/2008
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