Healthcare Provider Details

I. General information

NPI: 1821506510
Provider Name (Legal Business Name): BLUEGRASS HEARING CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 DOLPHIN DR STE 102
ELIZABETHTOWN KY
42701-7113
US

IV. Provider business mailing address

20 E 5TH ST
PARIS KY
40361-1840
US

V. Phone/Fax

Practice location:
  • Phone: 800-470-4757
  • Fax: 502-331-6271
Mailing address:
  • Phone: 859-987-3272
  • Fax: 859-987-3273

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