Organization
BLESSED ASSURANCE LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY DENISE WILSON (OWNER)
(865) 809-5304
Entity
Organization
Contact information
Practice address
113 HATCHER CREEK LN, WALLAND, TN 37886-2608
(865) 809-5304
(865) 982-2210
Mailing address
113 HATCHER CREEK LN, WALLAND, TN 37886-2608
(865) 809-5304
(865) 982-2210
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
TN
305R00000X
Preferred Provider Organization
—
—
305S00000X
Point of Service
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H445570
MEDICAID PROVIDER NUMBER
TN
Enumeration date
08/27/2011
Last updated
08/27/2011
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