Healthcare Provider Details

I. General information

NPI: 1407137581
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S RAINBOW BLVD STE. 105
LAS VEGAS NV
89146-4006
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD STE. 300-N
CLACKAMAS OR
97015-5738
US

V. Phone/Fax

Practice location:
  • Phone: 702-362-3138
  • Fax: 702-362-9983
Mailing address:
  • Phone: 503-659-5115
  • Fax: 503-659-5968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberNV20061148428
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberN20061148428
License Number StateNV

VIII. Authorized Official

Name: JEFFERY LONGTAIN
Title or Position: PRESIDENT
Credential:
Phone: 503-659-5115