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	:	1427518315
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	:	2790 CLAY EDWARDS DR STE 506
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-3243
Country	:	US
Telephone Number	:	816-472-4102
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	CHARLES LEWIS LAYTART
Credential	:
Telephone Number	:	952-915-6248

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	07/08/2019

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