Healthcare Provider Details

I. General information

NPI: 1386992865
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N. STATE OF FRANKLIN ROAD STE 5
JOHNSON CITY TN
37604
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD. STE 210
CLACKAMAS OR
97015-5738
US

V. Phone/Fax

Practice location:
  • Phone: 423-928-9285
  • Fax:
Mailing address:
  • Phone: 503-659-5115
  • Fax: 503-659-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2012-116705
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2012-116705
License Number StateTN

VIII. Authorized Official

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