Provider Demographics
NPI:1558549691
Name:BLUE RIDGE HEARING, INC
Entity Type:Organization
Organization Name:BLUE RIDGE HEARING, INC
Other - Org Name:MIRACLE-EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEARING AID SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LAWTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ETHERIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-937-6327
Mailing Address - Street 1:PO BOX 6115
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-6115
Mailing Address - Country:US
Mailing Address - Phone:800-937-6327
Mailing Address - Fax:
Practice Address - Street 1:3314 HEALY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1408
Practice Address - Country:US
Practice Address - Phone:800-937-6327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC451261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech