Provider Demographics
NPI:1649375932
Name:BLUE RIDGE HEARING CENTER INC
Entity type:Organization
Organization Name:BLUE RIDGE HEARING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:STOPHER
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC A
Authorized Official - Phone:540-432-0071
Mailing Address - Street 1:243 A NEFF AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3482
Mailing Address - Country:US
Mailing Address - Phone:540-432-0071
Mailing Address - Fax:540-432-6079
Practice Address - Street 1:243 A NEFF AVENUE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3482
Practice Address - Country:US
Practice Address - Phone:540-432-0071
Practice Address - Fax:540-432-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332S00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
118844OtherOPTIMA VENDOR
VAC06968OtherMEDICARE GROUP NO.
VA106785OtherANTHEM INS GROUP NO
49486OtherOPTIMA PROVIDER
VAC06968OtherMEDICARE GROUP NO.
VAC06968Medicare PIN