Organization
PRINCETON AUDIOLOGY CLINIC, INC.,
Active
Parent organization
PRINCETON AUDIOLOGY CLINIC, INC., DBA BLUE RIDGE HEARING
Other names
dba Blue Ridge Hearing and Balance Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRINCETON AUDIOLOGY CLINIC, INC., DBA BLUE RIDGE HEARING
Authorized official
ALAN L. DESMOND AU.D., CCC-A (PRESIDENT)
(304) 487-2487
Entity
Organization
Contact information
Practice address
2001 STADIUM DRIVE, SUITE D, BLUEFIELD, WV 24701
(304) 324-2954
(304) 324-2955
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
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
332S00000X
Hearing Aid Equipment
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810002482
—
WV
01
—
CC375
PALMETTO GBA RR MEDICARE
—
01
—
PR9319052
MEDICARE PALMETTO GBA PTAN NUMBER
—
Enumeration date
04/18/2007
Last updated
09/04/2014
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