Healthcare Provider Details

I. General information

NPI: 1740610104
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 SW 117TH AVE SUITE D
BEAVERTON OR
97005-5606
US

IV. Provider business mailing address

2510 E SUNSET RD UNIT 5-260
LAS VEGAS NV
89120-3511
US

V. Phone/Fax

Practice location:
  • Phone: 503-591-7027
  • Fax: 503-642-9435
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

VIII. Authorized Official

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