Healthcare Provider Details

I. General information

NPI: 1255979969
Provider Name (Legal Business Name): BLUE RIDGE HEARING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 STATE FARM RD STE 101
BOONE NC
28607-4862
US

IV. Provider business mailing address

870 STATE FARM RD STE 101
BOONE NC
28607-4862
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-4545
  • Fax: 828-264-3279
Mailing address:
  • Phone: 828-264-4545
  • Fax: 828-264-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD PAUL BRODEUR
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 828-264-4545