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General NPI Number Information
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NPI Number | 1285870451
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Entity Type | Organization
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Legal Business Name | BLUE MOUNTAIN MEDICAL INC
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 12/18/2008
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Provider Practice Location Address
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Address Line | 16515 MERIDIAN E SUITE 203 B
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City | PUYALLUP
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State | WA
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Zip | 98375-6251
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Country | US
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Telephone | 253-841-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 7320 216TH ST SW SUITE #30
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City | EDMONDS
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State | WA
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Zip | 98026-8006
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Country | US
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Telephone | 425-673-3773
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Fax | 425-673-3776
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALFRED ANTHONY TALL
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Credential | RRT, RPSGT
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Telephone | 425-673-3774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | LR00000073
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | LR00000073
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License Number State | WA
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