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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