Organization
PRINCETON AUDIOLOGY CLINIC, INC.,
Active
Organization
PRINCETON AUDIOLOGY CLINIC, INC.,
Active
Other names
dba Blue Ridge Hearing and Balance Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN LOUIS DESMOND AUD., CCC-A (PRESIDENT)
(304) 487-2487
Entity
Organization
Contact information
Practice address
508 NEW HOPE ROAD, SUITE #19, PRINCETON, WV 24740-2272
(304) 487-2487
(304) 431-3367
Mailing address
508 NEW HOPE ROAD, SUITE #19, PRINCETON, WV 24740-2272
(304) 487-2487
(304) 431-3367
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
—
—
235Z00000X
Speech-Language Pathologist
—
—
332S00000X
Hearing Aid Equipment
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810002482
—
WV
05
—
4250000-000
—
WV
05
—
4250000000
—
WV
01
—
CC3775
PALMETTO GBA RR MEDICARE
—
01
—
PR9319051
PALMETTO GBA MEDICARE PTAN NUMBER PCTN OFFICE
—
01
—
PR9319052
PALMETTO GBA MEDICARE PTAN NUMBER BLFD OFFICE
—
Enumeration date
03/01/2006
Last updated
06/05/2013
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