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General NPI Number Information
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NPI Number | 1366235905
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Entity Type | Organization
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Legal Business Name | BLUEGRASS HEARING CLINIC LLC
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 2498 DIXIE HWY STE 3
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City | FORT MITCHELL
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State | KY
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Zip | 41017-3010
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Country | US
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Telephone | 859-233-5212
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Fax |
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Provider Business Mailing Address
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Address Line | 100 JOHN SUTHERLAND DR STE 1
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-2424
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Country | US
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Telephone | 859-885-0150
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | TAYLOR EBEL
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Credential |
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Telephone | 859-885-0150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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