Healthcare Provider Details

I. General information

NPI: 1932451739
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E. MATTHEWS SUITE A
JONESBORO AR
72401-3081
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD. STE 300-N
CLACKAMAS OR
97015-5738
US

V. Phone/Fax

Practice location:
  • Phone: 870-268-1488
  • Fax: 870-268-1613
Mailing address:
  • Phone: 503-659-5115
  • Fax: 503-659-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000000002746
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number000000002746
License Number StateAR

VIII. Authorized Official

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