Provider Demographics
NPI:1942489976
Name:BLUEGRASS HEARING CLINIC, LLC
Entity Type:Organization
Organization Name:BLUEGRASS HEARING CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:MCCALL
Authorized Official - Last Name:LANTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-987-3272
Mailing Address - Street 1:116 MERIDIAN WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2876
Mailing Address - Country:US
Mailing Address - Phone:859-623-4458
Mailing Address - Fax:
Practice Address - Street 1:116 MERIDIAN WAY STE 1
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2876
Practice Address - Country:US
Practice Address - Phone:859-623-4458
Practice Address - Fax:859-623-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000041650OtherANTHEM
KY70006507Medicaid
KY70006507Medicaid