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General NPI Number Information
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NPI Number | 1558549691
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE HEARING, INC
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 01/31/2008
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Provider Practice Location Address
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Address Line | 3314 HEALY DR SUITE 106
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1408
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Country | US
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Telephone | 800-937-6327
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6115
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City | BLUEFIELD
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State | WV
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Zip | 24701-6115
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Country | US
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Telephone | 800-937-6327
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Fax |
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Authorized Official
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Title or Position | HEARING AID SPECIALIST
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Name | LAWTON ETHERIDGE
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Credential |
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Telephone | 800-937-6327
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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 | 451
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License Number State | NC
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