Healthcare Provider Details

I. General information

NPI: 1346321155
Provider Name (Legal Business Name): BLUE MOUNTAIN DIAGNOSTIC IMAGING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SOUTHGATE SUITE 7
PENDLETON OR
97801-3974
US

IV. Provider business mailing address

1100 SOUTHGATE SUITE 7
PENDLETON OR
97801-3974
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-2431
  • Fax: 541-276-1947
Mailing address:
  • Phone: 541-276-2431
  • Fax: 541-276-1947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNNE FITZGERALD
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-276-2431