Provider Demographics
NPI:1851326490
Name:BLOUNT MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:BLOUNT MEMORIAL HOSPITAL, INC.
Other - Org Name:PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR MSO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOBBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-273-1750
Mailing Address - Street 1:PO BOX 5629
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5629
Mailing Address - Country:US
Mailing Address - Phone:865-980-4844
Mailing Address - Fax:865-977-4787
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:865-980-4844
Practice Address - Fax:865-977-4787
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLOUNT MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-12
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724297Medicaid
TN3724297Medicaid
TN3724297Medicare PIN