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General NPI Number Information
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NPI Number | 1790980100
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE HEARING CARE, LLC
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 10/11/2013
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Provider Practice Location Address
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Address Line | 510 FLEMING ST STE D
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City | HENDERSONVILLE
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State | NC
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Zip | 28739-4250
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Country | US
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Telephone | 828-696-2006
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Fax |
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Provider Business Mailing Address
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Address Line | 510 FLEMING ST STE D
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City | HENDERSONVILLE
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State | NC
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Zip | 28739-4250
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Country | US
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Telephone | 828-696-2006
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Fax |
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Authorized Official
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Title or Position | AUDIOLOGIST, OWNER
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Name | MR. JOSEPH PATTERSON CLARK
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Credential | M.A., CCC-A
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Telephone | 828-696-2006
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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 | 5333
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License Number State | NC
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