Provider Demographics
NPI:1619939071
Name:PRISMA HEALTH-BLOUNT MEMORIAL HOSPITAL, INC
Entity type:Organization
Organization Name:PRISMA HEALTH-BLOUNT MEMORIAL HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-522-8611
Mailing Address - Street 1:DEPT #888608
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-0001
Mailing Address - Country:US
Mailing Address - Phone:865-983-7211
Mailing Address - Fax:865-980-4868
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:865-983-7211
Practice Address - Fax:865-980-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0440011Medicaid
TN100020066OtherPHP TENN CARE
TN0701652OtherCIGNA COMMERCIAL
TN1000213OtherBLUE CROSS ACUTE CARE
TN1000213OtherBLUE CROSS ACUTE CARE