Provider Demographics
NPI:1578880415
Name:BLUE MOUNTAIN HOSPITAL
Entity Type:Organization
Organization Name:BLUE MOUNTAIN HOSPITAL
Other - Org Name:BLUE MOUNTAIN HOSPITAL-SWING BEDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LORIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-678-3993
Mailing Address - Street 1:802 S 200 W
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-3910
Mailing Address - Country:US
Mailing Address - Phone:435-678-3993
Mailing Address - Fax:435-678-3992
Practice Address - Street 1:802 S 200 W
Practice Address - Street 2:
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511-3910
Practice Address - Country:US
Practice Address - Phone:435-678-3993
Practice Address - Fax:435-678-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2009-HOSP-90347275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit