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	237600000X	Audiologist-Hearing Aid Fitter

General Provider Information

NPI Number	:	1104227891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND HEARING CENTERS, INC.

Provider Business Mailing Address
First Line	:	8800 SE SUNNYSIDE RD
Second Line	:	SUITE 300 N
City	:	CLACKAMAS
State	:	OR
Zip	:	97015-5738
Country	:	US
Telephone Number	:	281-286-2999
Fax Number	:	512-607-4893

Provider Business Practice Location Address
First Line	:	5920 S RAINBOW BLVD
Second Line	:	SUITE 9
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4208
Country	:	US
Telephone Number	:	702-362-3138
Fax Number	:	702-873-2050

Authorized Official
Title or Position	:	SR. DIRECTOR OF RETAIL OPERATIONS
Name	:	MELONY WINCHESTER
Credential	:
Telephone Number	:	503-659-5115

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	11/18/2016

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