Provider Demographics
NPI:1710611579
Name:BLUE RIDGE HEARING, LLC
Entity Type:Organization
Organization Name:BLUE RIDGE HEARING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIS/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:828-543-9112
Mailing Address - Street 1:3314 16TH AVE SE STE 207
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9694
Mailing Address - Country:US
Mailing Address - Phone:828-543-9112
Mailing Address - Fax:
Practice Address - Street 1:3314 16TH AVE SE STE 207
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9694
Practice Address - Country:US
Practice Address - Phone:828-543-9112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty