Healthcare Provider Details

I. General information

NPI: 1356386684
Provider Name (Legal Business Name): BLUE MOUNTAIN PATHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 SE 3RD STREET
PENDLETON OR
97801
US

IV. Provider business mailing address

PO BOX 1049
PENDLETON OR
97801-0050
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-1184
  • Fax: 541-278-9365
Mailing address:
  • Phone: 541-966-1184
  • Fax: 541-278-9365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2618
License Number StateOR

VIII. Authorized Official

Name: LAWRENCE J ADAMS
Title or Position: PRESIDENT OF COMPANY
Credential: MD
Phone: 541-966-1184