Healthcare Provider Details

I. General information

NPI: 1932436565
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 W 2ND ST
HASTINGS NE
68901-4606
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 402-463-1083
  • Fax: 402-463-1083
Mailing address:
  • Phone: 503-257-6800
  • Fax: 503-257-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number578
License Number StateNE

VIII. Authorized Official

Name: MR. JEFFREY LONGTAIN
Title or Position: PRESIDENT
Credential:
Phone: 503-257-6800