Healthcare Provider Details

I. General information

NPI: 1255021986
Provider Name (Legal Business Name): NORTHLAND HEARING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 N ILLINOIS ST STE 105
FAIRVIEW HEIGHTS IL
62208-3500
US

IV. Provider business mailing address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

V. Phone/Fax

Practice location:
  • Phone: 618-277-8111
  • Fax: 952-995-8872
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BEE XIONG
Title or Position: MANAGER OF REVENUE CYCLE
Credential:
Phone: 952-995-6601