Provider Demographics
NPI:1023352911
Name:BLUE RIDGE HEARING, INC
Entity type:Organization
Organization Name:BLUE RIDGE HEARING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:465 BLUE PRINCE RD
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-9577
Mailing Address - Country:US
Mailing Address - Phone:304-324-8358
Mailing Address - Fax:304-324-8308
Practice Address - Street 1:465 BLUE PRINCE RD
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-9577
Practice Address - Country:US
Practice Address - Phone:304-324-8358
Practice Address - Fax:304-324-8308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV801332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment