Healthcare Provider Details

I. General information

NPI: 1154306884
Provider Name (Legal Business Name): BLUE MOUNTAIN MEDICAL GOUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S 2ND AVE
WALLA WALLA WA
99362-4118
US

IV. Provider business mailing address

1111 S 2ND AVE
WALLA WALLA WA
99362-4118
US

V. Phone/Fax

Practice location:
  • Phone: 509-522-0100
  • Fax: 509-527-8010
Mailing address:
  • Phone: 509-522-0100
  • Fax: 509-527-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name: MS. KATHY A. STRICKLER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 509-522-0100