Provider Demographics
NPI:1356414395
Name:BLUE MOUNTAIN HOSPITAL DISTRICT
Entity type:Organization
Organization Name:BLUE MOUNTAIN HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-575-4151
Mailing Address - Street 1:170 FORD ROAD
Mailing Address - Street 2:
Mailing Address - City:JOHN DAY
Mailing Address - State:OR
Mailing Address - Zip Code:97845-2009
Mailing Address - Country:US
Mailing Address - Phone:541-575-1311
Mailing Address - Fax:541-575-0650
Practice Address - Street 1:170 FORD RD
Practice Address - Street 2:
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845-2009
Practice Address - Country:US
Practice Address - Phone:541-575-1311
Practice Address - Fax:541-575-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2086H0002X
OR14-0703282NC0060X
282NC0060X
OR12013416L0300X, 3416L0300X
OR140703282NC0060X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative MedicineGroup - Multi-Specialty
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500626499Medicaid
OR500604998Medicaid
OR278713Medicaid
OR295687Medicaid
OR50060499Medicaid
OR018507Medicaid
OR278713Medicaid
OR381305Medicare Oscar/Certification
OR381552Medicare PIN
OR018507Medicaid
OR38-7045Medicare PIN