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General NPI Number Information
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NPI Number | 1205314598
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Entity Type | Organization
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Legal Business Name | BLUE RIBBON HEARING, LLC
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 606 S 4TH AVE
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City | BRIGHTON
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State | CO
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Zip | 80601-3202
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Country | US
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Telephone | 303-659-8760
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Fax | 303-659-8760
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Provider Business Mailing Address
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Address Line | 12114 HANNIBAL ST
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City | COMMERCE CITY
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State | CO
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Zip | 80603-6959
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Country | US
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Telephone | 303-906-8886
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Fax | 303-659-8760
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Authorized Official
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Title or Position | OWNER, HEARING AID DISPENSER
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Name | JOHN WILLIAM WILSON
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Credential | BC-HIS
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Telephone | 303-659-8760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 210
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License Number State | CO
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