Provider Demographics
NPI:1346847522
Name:BLUE MOUNTAIN DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:BLUE MOUNTAIN DIAGNOSTICS LLC
Other - Org Name:BLUE MOUNTAIN DIAGNOSTICS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-907-8820
Mailing Address - Street 1:10 ENTERPRISE BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3554
Mailing Address - Country:US
Mailing Address - Phone:864-263-3302
Mailing Address - Fax:
Practice Address - Street 1:10 ENTERPRISE BLVD STE 206
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3554
Practice Address - Country:US
Practice Address - Phone:864-263-3302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory