Provider Demographics
NPI:1396025854
Name:BLESSED ASSURANCE LLC.
Entity Type:Organization
Organization Name:BLESSED ASSURANCE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-809-5304
Mailing Address - Street 1:113 HATCHER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:WALLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37886-2608
Mailing Address - Country:US
Mailing Address - Phone:865-809-5304
Mailing Address - Fax:865-982-2210
Practice Address - Street 1:113 HATCHER CREEK LN
Practice Address - Street 2:
Practice Address - City:WALLAND
Practice Address - State:TN
Practice Address - Zip Code:37886-2608
Practice Address - Country:US
Practice Address - Phone:865-809-5304
Practice Address - Fax:865-982-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN302F00000X
305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445570OtherMEDICAID PROVIDER NUMBER