Healthcare Provider Details

I. General information

NPI: 1285870451
Provider Name (Legal Business Name): BLUE MOUNTAIN MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16515 MERIDIAN E SUITE 203 B
PUYALLUP WA
98375-6251
US

IV. Provider business mailing address

7320 216TH ST SW SUITE #30
EDMONDS WA
98026-8006
US

V. Phone/Fax

Practice location:
  • Phone: 253-841-2700
  • Fax:
Mailing address:
  • Phone: 425-673-3773
  • Fax: 425-673-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberLR00000073
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberLR00000073
License Number StateWA

VIII. Authorized Official

Name: MR. ALFRED ANTHONY TALL
Title or Position: PRESIDENT
Credential: RRT, RPSGT
Phone: 425-673-3774