Provider Demographics
NPI:1275649519
Name:BLOUNT ORTHOPAEDIC ASSOCIATES PA
Entity Type:Organization
Organization Name:BLOUNT ORTHOPAEDIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BEARDSLEY-RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-549-4857
Mailing Address - Street 1:2001 LAUREL AVE
Mailing Address - Street 2:SUITE 402 NEWLAND PROFESSIONAL BLDG.
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1810
Mailing Address - Country:US
Mailing Address - Phone:865-632-5577
Mailing Address - Fax:865-632-5584
Practice Address - Street 1:2001 LAUREL AVE
Practice Address - Street 2:SUITE 402 NEWLAND PROFESSIONAL BLDG.
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1810
Practice Address - Country:US
Practice Address - Phone:865-632-5577
Practice Address - Fax:865-632-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24287207X00000X
TN15337207X00000X
TN37760207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3073961Medicaid
TN3886823Medicaid
TN3801105Medicaid
TN3801105Medicaid
TN3073961Medicaid
TNF52917Medicare UPIN
TN0784600001Medicare NSC