=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922353432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUEGRASS HEARING CLINIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2012
-----------------------------------------------------
Last Update Date | 10/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 E 5TH ST
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-987-3272
-----------------------------------------------------
Fax | 859-987-3273
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 MERIDIAN WAY STE 1
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40475-2876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-623-4458
-----------------------------------------------------
Fax | 859-623-4459
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | SHERRY MCCALL LANTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-987-3272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231HA2400X
-----------------------------------------------------
Taxonomy Name | Assistive Technology Practitioner Audiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------