Healthcare Provider Details

I. General information

NPI: 1073801288
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

3301 NEW MEXICO AVE. NW SUITE 125
WASHINGTON DC
20016-3609
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 202-621-6374
  • Fax: 413-584-1866
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 NumberAUD000051
License Number StateDC

VIII. Authorized Official

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