Provider Demographics
NPI:1417979543
Name:BRISTOL REGIONAL SPEECH & HEARING CENTER
Entity Type:Organization
Organization Name:BRISTOL REGIONAL SPEECH & HEARING CENTER
Other - Org Name:LEBANON SPEECH AND HEARING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE & ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-669-6331
Mailing Address - Street 1:359 COMMONWEALTH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3867
Mailing Address - Country:US
Mailing Address - Phone:276-669-6331
Mailing Address - Fax:276-669-2950
Practice Address - Street 1:359 COMMONWEALTH AVE STE 100
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3867
Practice Address - Country:US
Practice Address - Phone:276-669-6331
Practice Address - Fax:276-669-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty