Provider Demographics
NPI:1407326978
Name:BURDOIN MOUNTAIN MATERNITY CARE, PLLC
Entity Type:Organization
Organization Name:BURDOIN MOUNTAIN MATERNITY CARE, PLLC
Other - Org Name:BURDOIN MOUNTAIN MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARDONNAY
Authorized Official - Middle Name:JULIA
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:509-289-2119
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-0886
Mailing Address - Country:US
Mailing Address - Phone:509-289-2119
Mailing Address - Fax:509-232-5809
Practice Address - Street 1:181 W JEWETT BLVD
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-8974
Practice Address - Country:US
Practice Address - Phone:509-289-2119
Practice Address - Fax:509-493-1264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care