27D0410840 CLIA NUMBER - BLUE MOUNTAIN CLINIC

Laboratory Demographics

  • CLIA Code: 27D0410840
  • Facility Name: BLUE MOUNTAIN CLINIC
  • Facility Address: 610 NORTH CALIFORNIA STREET
    MISSOULA, MT
    ZIP 59802
  • Facility Phone: 406 721-1646
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. ERIC A. RAVITZ
  • NPI Number: 1407987548
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 27D0410840
LAB Type Physician Office
Facility Name BLUE MOUNTAIN CLINIC
Street 610 NORTH CALIFORNIA STREET
City MISSOULA
State MT
ZIP 59802
Phone 406 721-1646
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/26/2025
Certificate Expiration Date 6/25/2027
Facility Type Physician Office
Lab Director DR. ERIC A. RAVITZ

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This page was last updated on: 9/29/2025