Provider Demographics
NPI:1023004363
Name:BLOUNT MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:BLOUNT MEMORIAL HOSPITAL, INC.
Other - Org Name:BLOUNT MEMORIAL HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:I
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:HEINEMANN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:865-977-5533
Mailing Address - Street 1:1095 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5134
Mailing Address - Country:US
Mailing Address - Phone:865-981-2160
Mailing Address - Fax:865-981-2258
Practice Address - Street 1:907 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5015
Practice Address - Country:US
Practice Address - Phone:865-981-2172
Practice Address - Fax:865-981-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0336390001251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0200139OtherBCBS PROVIDER NUMBER
TN0200139OtherBCBS PROVIDER NUMBER