Healthcare Provider Details

I. General information

NPI: 1932349271
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S 16TH ST
PHILADELPHIA PA
19102-2802
US

IV. Provider business mailing address

10570 SE WASHINGTON ST SUITE 202
PORTLAND OR
97216-2846
US

V. Phone/Fax

Practice location:
  • Phone: 215-563-3885
  • Fax:
Mailing address:
  • Phone: 503-257-6800
  • Fax: 503-257-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: BRIAN PROSKI
Title or Position: MEDICAL BILLING SPECIALIST
Credential:
Phone: 503-257-6800