| Blue Mountain Medical Goup, Pllc | |
|
1111 S 2nd Ave Walla Walla WA 99362-4118 | |
| (509) 522-0100 | |
| (509) 527-8010 |
| Full Name | Blue Mountain Medical Goup, Pllc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 1111 S 2nd Ave, Walla Walla, Washington |
| Authorized Official Name and Position | Kathy A. Strickler (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 5095220100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Mountain Medical Goup, Pllc 1111 S 2nd Ave Walla Walla WA 99362-4118 Ph: (509) 522-0100 | Blue Mountain Medical Goup, Pllc 1111 S 2nd Ave Walla Walla WA 99362-4118 Ph: (509) 522-0100 |
| NPI Number | 1154306884 |
|---|---|
| Provider Enumeration Date | 12/15/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154306884 | NPI | - | NPPES |
| 00615 | Medicaid | OR | |
| 287665 | Medicaid | OR | |
| 7103260 | Medicaid | WA | |
| 71121170 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (Washington) | Primary |
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