Healthcare Provider Details

I. General information

NPI: 1174811384
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 AIRPORT BLVD. SUITE A
MOBILE AL
36695
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD. STE. 300-N
CLACKAMAS OR
97015-5703
US

V. Phone/Fax

Practice location:
  • Phone: 251-639-3466
  • Fax: 202-621-6378
Mailing address:
  • Phone: 503-659-5115
  • Fax: 503-659-5968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1034A
License Number StateAL

VIII. Authorized Official

Name: JEFFREY LONGTAIN
Title or Position: PRESIDENT
Credential:
Phone: 503-659-5115