Provider Demographics
NPI:1255979969
Name:BLUE RIDGE HEARING CENTER, LLC
Entity type:Organization
Organization Name:BLUE RIDGE HEARING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BRODEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-264-4545
Mailing Address - Street 1:870 STATE FARM RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4862
Mailing Address - Country:US
Mailing Address - Phone:828-264-4545
Mailing Address - Fax:828-264-3279
Practice Address - Street 1:870 STATE FARM RD STE 101
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4862
Practice Address - Country:US
Practice Address - Phone:828-264-4545
Practice Address - Fax:828-264-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty