Provider Demographics
NPI:1790980100
Name:BLUE RIDGE HEARING CARE, LLC
Entity Type:Organization
Organization Name:BLUE RIDGE HEARING CARE, LLC
Other - Org Name:BLUE RIDGE HEARING CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATTERSON
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A
Authorized Official - Phone:828-696-2006
Mailing Address - Street 1:510 FLEMING ST STE D
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4250
Mailing Address - Country:US
Mailing Address - Phone:828-696-2006
Mailing Address - Fax:
Practice Address - Street 1:510 FLEMING ST STE D
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4250
Practice Address - Country:US
Practice Address - Phone:828-696-2006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5333231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14135OtherBCBSNC
NC2699776Medicare ID - Type UnspecifiedBLUE RIDGE HEARING CARE
NCQ60593Medicare UPIN
P00475251Medicare PIN