Healthcare Provider Details

I. General information

NPI: 1205181716
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

29 S MAYSVILLE ST
MT STERLING KY
40353-1354
US

IV. Provider business mailing address

20 E 5TH ST
PARIS KY
40361-1840
US

V. Phone/Fax

Practice location:
  • Phone: 859-432-8402
  • Fax: 859-432-8407
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
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number2717
License Number StateKY

VIII. Authorized Official

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