Healthcare Provider Details

I. General information

NPI: 1780968602
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

IV. Provider business mailing address

1001 E SUNSET RD UNIT 96595
LAS VEGAS NV
89193-1246
US

V. Phone/Fax

Practice location:
  • Phone: 952-947-4700
  • Fax: 952-828-6946
Mailing address:
  • Phone: 702-798-0113
  • Fax: 866-291-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY LONGTAIN
Title or Position: PRESIDENT
Credential:
Phone: 702-798-0113