Healthcare Provider Details

I. General information

NPI: 1922315068
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 SAINT MICHAELS DR SUITE 1204
SANTA FE NM
87505-7619
US

IV. Provider business mailing address

10570 SE WASHINGTON ST SUITE 210
PORTLAND OR
97216-2846
US

V. Phone/Fax

Practice location:
  • Phone: 505-986-9108
  • Fax:
Mailing address:
  • Phone: 503-257-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT NELSON
Title or Position: VP FINANCE
Credential:
Phone: 952-828-9120