MEDICARE: BLUEGRASS HEARING CLINIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231HA2400X	Assistive Technology Practitioner Audiologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000041650	OTHER	KY	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942489976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS HEARING CLINIC, LLC

Provider Business Mailing Address
First Line	:	116 MERIDIAN WAY STE 1
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2876
Country	:	US
Telephone Number	:	859-623-4458
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 MERIDIAN WAY STE 1
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2876
Country	:	US
Telephone Number	:	859-623-4458
Fax Number	:	859-623-4459

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	SHERRY MCCALL LANTER
Credential	:
Telephone Number	:	859-987-3272

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	10/14/2020

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