Healthcare Provider Details

I. General information

NPI: 1962498816
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 KIMBALL AVE STE. 300
WATERLOO IA
50702-5047
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 319-272-2500
  • Fax: 319-272-2503
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 Code237700000X
TaxonomyHearing Instrument Specialist
License Number67
License Number StateIA

VIII. Authorized Official

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