Organization
BLUE MOUNTAIN FAMILY HEALTH PLLC
Active
Other names
Blue Mountain Family Health
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JAMES BLACK (ADMINISTRATOR)
(509) 751-5500
Entity
Organization
Contact information
Practice address
1268 BRIDGE ST, CLARKSTON, WA 99403-2219
(509) 751-5500
(509) 751-1059
Mailing address
1268 BRIDGE ST, CLARKSTON, WA 99403-2219
(509) 751-5500
(509) 751-1059
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00045393
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7130354
—
WA
05
—
807278700
—
ID
05
—
80745000
—
ID
05
—
8439333
—
WA
Enumeration date
11/27/2006
Last updated
05/21/2024
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