Healthcare Provider Details

I. General information

NPI: 1982171237
Provider Name (Legal Business Name): BLUEGRASS HEARING CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MEDPARK WEST SUITE 2
SOMERSET KY
42503
US

IV. Provider business mailing address

20 E 5TH ST
PARIS KY
40361-1840
US

V. Phone/Fax

Practice location:
  • Phone: 606-492-2009
  • Fax:
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: MRS. SHERRY MCCALL LANTER
Title or Position: CEO/CFO/OWNER
Credential:
Phone: 859-987-3272