MEDICARE: NORTHLAND HEARING CENTERS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1003373663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND HEARING CENTERS, INC.

Provider Business Mailing Address
First Line	:	6700 WASHINGTON AVE S
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3405
Country	:	US
Telephone Number	:	800-328-8602
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-1422
Country	:	US
Telephone Number	:	954-271-8006
Fax Number	:	954-271-8022

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	HEATHER PEDREGUERA
Credential	:
Telephone Number	:	952-947-4602

Provider Enumeration Date	:	03/01/2019
Last Update Date	:	05/31/2019

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