Provider Demographics
NPI:1306823976
Name:WESTSIDE GASTROINTESTINAL SPECIALISTS PLLC
Entity Type:Organization
Organization Name:WESTSIDE GASTROINTESTINAL SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPV
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-539-5372
Mailing Address - Street 1:9330 PARK WEST BLVD
Mailing Address - Street 2:STE 506
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-539-5372
Mailing Address - Fax:865-539-5369
Practice Address - Street 1:9330 PARK WEST BLVD
Practice Address - Street 2:STE 506
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-539-5372
Practice Address - Fax:865-539-5369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD000021220174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4087556OtherBCBS PROV #
TN3726442Medicaid
TN3726442Medicare ID - Type Unspecified