Provider Demographics
NPI:1144286709
Name:BLOUNT GASTROENTEROLOGY ASSOC PC
Entity type:Organization
Organization Name:BLOUNT GASTROENTEROLOGY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-983-0073
Mailing Address - Street 1:1706 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-6204
Mailing Address - Country:US
Mailing Address - Phone:865-983-0073
Mailing Address - Fax:865-984-1731
Practice Address - Street 1:1706 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-6204
Practice Address - Country:US
Practice Address - Phone:865-983-0073
Practice Address - Fax:865-984-1731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3381364Medicaid
TN3381364Medicaid