Healthcare Provider Details

I. General information

NPI: 1710157276
Provider Name (Legal Business Name): OREGON HEARING AND SPEECH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 SE MOUNT HOOD HWY
GRESHAM OR
97080-9280
US

IV. Provider business mailing address

735 SE MOUNT HOOD HWY PO BOX 623
GRESHAM OR
97080-9280
US

V. Phone/Fax

Practice location:
  • Phone: 503-492-8000
  • Fax: 503-492-8444
Mailing address:
  • Phone: 503-492-8000
  • Fax: 503-492-8444

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier028074
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: JOHN WILLIAM DILLOW
Title or Position: OWNER
Credential: BA
Phone: 503-492-8000