Healthcare Provider Details

I. General information

NPI: 1649452848
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E MCCORD ST STE 1
CENTRALIA IL
62801-3703
US

IV. Provider business mailing address

10570 SE WASHINGTON ST STE 202
PORTLAND OR
97216-2846
US

V. Phone/Fax

Practice location:
  • Phone: 618-532-7770
  • Fax: 618-532-7700
Mailing address:
  • Phone: 503-257-6800
  • Fax: 503-257-6810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: SCOTT NELSON
Title or Position: VP FINANCE
Credential:
Phone: 852-828-9210