Provider Demographics
NPI:1710201934
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:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-324-8358
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:304-324-8358
Mailing Address - Fax:304-324-8308
Practice Address - Street 1:11504 MIDLOTHIAN TPKE
Practice Address - Street 2:MIRACLE-EAR @ SEARS
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4746
Practice Address - Country:US
Practice Address - Phone:804-378-9957
Practice Address - Fax:304-324-8308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV801261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech