Healthcare Provider Details

I. General information

NPI: 1588919096
Provider Name (Legal Business Name): BLUEGRASS HEARING CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 KY HIGHWAY 36 E SUITE A
CYNTHIANA KY
41031-7490
US

IV. Provider business mailing address

1036 AMBERLEY WAY
RICHMOND KY
40475-8979
US

V. Phone/Fax

Practice location:
  • Phone: 800-470-4757
  • Fax: 859-623-4459
Mailing address:
  • Phone: 800-470-4757
  • Fax: 859-623-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State

VIII. Authorized Official

Name: SHERRY MCCALL LANTER
Title or Position: OWNER/CEO
Credential:
Phone: 859-987-3272