Provider Demographics
NPI:1356368310
Name:BLOUNT MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:BLOUNT MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BMH MSO DIRECTOR
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:865-273-1752
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:116 CHANTILLY LN
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-6102
Practice Address - Country:US
Practice Address - Phone:865-273-1616
Practice Address - Fax:865-273-1645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLOUNT MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-16
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724297Medicare PIN