Healthcare Provider Details

I. General information

NPI: 1639530132
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1994 GALLATIN PIKE N SUITE 200
MADISON TN
37115-2026
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD SUITE 300 N
CLACKAMAS OR
97015-5738
US

V. Phone/Fax

Practice location:
  • Phone: 615-851-9005
  • Fax: 615-851-9007
Mailing address:
  • Phone: 281-286-2999
  • Fax: 512-607-4893

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: MELONY WINCHESTER
Title or Position: SR. DIRECTOR OF RETAIL OPERATIONS
Credential:
Phone: 503-659-5115