Provider Demographics
NPI:1962621888
Name:BLUE MOUNTAIN ASSOCIATES, LLC
Entity type:Organization
Organization Name:BLUE MOUNTAIN ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGGEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROGOITTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-962-0162
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850
Mailing Address - Country:US
Mailing Address - Phone:541-962-0162
Mailing Address - Fax:541-962-0119
Practice Address - Street 1:1101 I AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850
Practice Address - Country:US
Practice Address - Phone:541-962-0162
Practice Address - Fax:541-962-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR118112Medicare ID - Type UnspecifiedGROUP MEDICARE #
R118112Medicare PIN