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General NPI Number Information
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NPI Number | 1356386684
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Entity Type | Organization
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Legal Business Name | BLUE MOUNTAIN PATHOLOGY INC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 434 SE 3RD STREET
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City | PENDLETON
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State | OR
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Zip | 97801
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Country | US
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Telephone | 541-966-1184
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Fax | 541-278-9365
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Provider Business Mailing Address
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Address Line | PO BOX 1049
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City | PENDLETON
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State | OR
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Zip | 97801-0050
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Country | US
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Telephone | 541-966-1184
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Fax | 541-278-9365
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Authorized Official
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Title or Position | PRESIDENT OF COMPANY
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Name | LAWRENCE J ADAMS
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Credential | MD
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Telephone | 541-966-1184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 2618
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License Number State | OR
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