Provider Demographics
NPI:1356386684
Name:BLUE MOUNTAIN PATHOLOGY INC
Entity type:Organization
Organization Name:BLUE MOUNTAIN PATHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-966-1184
Mailing Address - Street 1:PO BOX 1049
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0050
Mailing Address - Country:US
Mailing Address - Phone:541-966-1184
Mailing Address - Fax:541-278-9365
Practice Address - Street 1:434 SE 3RD STREET
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-966-1184
Practice Address - Fax:541-278-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2618207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN2826OtherRR MEDICARE
OR028733Medicaid
OR083931000OtherBLUE CROSS BLUE SHIELD
WA7032782Medicaid
OR028733Medicaid