Healthcare Provider Details

I. General information

NPI: 1134404353
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MAIN ST
MARSHALLTOWN IA
50158-4917
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 888-483-0832
  • Fax:
Mailing address:
  • Phone: 503-659-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateNULL

VIII. Authorized Official

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