MEDICARE: NORTHLAND HEARING CENTER, 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	:	1114524220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND HEARING CENTER, 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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 S WALNUT ST
Second Line	:
City	:	STARKE
State	:	FL
Zip	:	32091-4413
Country	:	US
Telephone Number	:	904-964-4327
Fax Number	:	904-368-0574

Authorized Official
Title or Position	:	BILLING SPECIALIST
Name	:	MEE VANG
Credential	:
Telephone Number	:	952-828-9127

Provider Enumeration Date	:	10/02/2020
Last Update Date	:	05/08/2024

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