Provider Demographics
NPI:1245251156
Name:BLOUNT MEMORIAL OCCUPATIONAL HEALTH
Entity type:Organization
Organization Name:BLOUNT MEMORIAL OCCUPATIONAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSITANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-273-1701
Mailing Address - Street 1:110 DEER XING
Mailing Address - Street 2:
Mailing Address - City:VONORE
Mailing Address - State:TN
Mailing Address - Zip Code:37885-2133
Mailing Address - Country:US
Mailing Address - Phone:423-884-6958
Mailing Address - Fax:423-884-6959
Practice Address - Street 1:110 DEER XING
Practice Address - Street 2:
Practice Address - City:VONORE
Practice Address - State:TN
Practice Address - Zip Code:37885-2133
Practice Address - Country:US
Practice Address - Phone:423-884-6958
Practice Address - Fax:423-884-6959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Not Answered261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Not Answered261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX ID