Provider Demographics
NPI:1518953801
Name:BLOUNT MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:BLOUNT MEMORIAL HOSPITAL, INC.
Other - Org Name:BLOUNT MEMORIAL HOME EQUIPMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:NARAMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-977-5533
Mailing Address - Street 1:531 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804
Mailing Address - Country:US
Mailing Address - Phone:865-980-5300
Mailing Address - Fax:865-980-5305
Practice Address - Street 1:531 HIGH STREET
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804
Practice Address - Country:US
Practice Address - Phone:865-980-5300
Practice Address - Fax:865-980-5305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLOUNT MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-22
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN#630332B00000X
332BX2000X
TN#1655332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454194Medicaid
TN4042681OtherBLUE CROSS BLUE SHIELD
TN4042681OtherBLUE CROSS BLUE SHIELD
TN0336390002Medicare ID - Type Unspecified