| Blackstone Medical, PLLC | |
|
688 E Vine St Ste 16 Murray UT 84107-5541 | |
| (801) 688-0210 | |
| Not Available |
| Full Name | Blackstone Medical, PLLC |
|---|---|
| Speciality | Family Medicine |
| Location | 688 E Vine St Ste 16, Murray, Utah |
| Authorized Official Name and Position | Khalid Amro Hararah (CEO/OWNER) |
| Authorized Official Contact | 8016880210 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blackstone Medical, PLLC 688 E Vine St Ste 16 Murray UT 84107-5541 Ph: (801) 509-9138 | Blackstone Medical, PLLC 688 E Vine St Ste 16 Murray UT 84107-5541 Ph: (801) 688-0210 |
| NPI Number | 1902675556 |
|---|---|
| Provider Enumeration Date | 12/25/2023 |
| Last Update Date | 09/04/2025 |
| Certification Date | 09/04/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902675556 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 2083P0011X | Preventive Medicine - Undersea And Hyperbaric Medicine | () | Secondary |
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