Healthcare Provider Details

I. General information

NPI: 1124354154
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 W. HORIZON RIDGE PKWY.
HENDERSON NV
89052
US

IV. Provider business mailing address

10570 SE WASHINGTON ST. SUITE 210
PORTLAND OR
97216
US

V. Phone/Fax

Practice location:
  • Phone: 714-213-2389
  • Fax:
Mailing address:
  • Phone: 503-257-6800
  • Fax: 503-257-0288

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: JEFFREY L LONGTAIN
Title or Position: PRESIDENT
Credential:
Phone: 503-257-6800