Healthcare Provider Details

I. General information

NPI: 1194268896
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 MAIN AVE
BROOKINGS SD
57006-1424
US

IV. Provider business mailing address

6425 FLYING CLOUD DR
EDEN PRAIRIE MN
55344-3305
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-1024
  • Fax: 507-829-9489
Mailing address:
  • Phone: 281-286-2999
  • Fax: 512-607-4893

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: MELONY WINCHESTER
Title or Position: SENIOR DIRECTOR OF RETAIL OPERATION
Credential:
Phone: 281-286-2999