| Blue Mountain Clinic, Inc. | |
|
610 N California St Missoula MT 59802-3950 | |
| (406) 721-1946 | |
| (406) 543-9890 |
| Full Name | Blue Mountain Clinic, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 610 N California St, Missoula, Montana |
| Authorized Official Name and Position | Annie Hansen (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4067211646 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Mountain Clinic, Inc. 610 N California St Missoula MT 59802-3950 Ph: (406) 721-1946 | Blue Mountain Clinic, Inc. 610 N California St Missoula MT 59802-3950 Ph: (406) 721-1946 |
| NPI Number | 1407987548 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 05/24/2016 |
| Medicare PECOS PAC ID | 4688600984 |
|---|---|
| Medicare Enrollment ID | O20050708000503 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407987548 | NPI | - | NPPES |
| 0218478 | Medicaid | MT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 9607 (Montana) | Primary |
| Provider Name | Deanna L Phinney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780714071 PECOS PAC ID: 5193711091 Enrollment ID: I20040424000465 |
| Provider Name | Eric A Ravitz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215034681 PECOS PAC ID: 5597791897 Enrollment ID: I20050708000527 |
| Provider Name | Alison B Charman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669543039 PECOS PAC ID: 6204860539 Enrollment ID: I20050926000437 |
| Provider Name | Joey M Banks |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528096146 PECOS PAC ID: 6305898073 Enrollment ID: I20121022000560 |
| Provider Name | Andrea Strizich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356721732 PECOS PAC ID: 0446552806 Enrollment ID: I20151231001949 |
| Provider Name | Vasa Parsons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174056170 PECOS PAC ID: 0840566147 Enrollment ID: I20171031001916 |
| Provider Name | Caitlin Marie Blau |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992155980 PECOS PAC ID: 1153658588 Enrollment ID: I20190808000994 |
| Provider Name | Adriana Raquel Ramos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568103364 PECOS PAC ID: 1850771924 Enrollment ID: I20220707000361 |
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