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General NPI Number Information
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NPI Number | 1386992865
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Entity Type | Organization
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Legal Business Name | NORTHLAND HEARING CENTERS, INC.
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 701 N. STATE OF FRANKLIN ROAD STE 5
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City | JOHNSON CITY
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State | TN
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Zip | 37604
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Country | US
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Telephone | 423-928-9285
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Fax |
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Provider Business Mailing Address
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Address Line | 8800 SE SUNNYSIDE RD. STE 210
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City | CLACKAMAS
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State | OR
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Zip | 97015-5738
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Country | US
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Telephone | 503-659-5115
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Fax | 503-659-5887
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY LONGTAIN
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Credential |
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Telephone | 503-659-5115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 2012-116705
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2012-116705
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License Number State | TN
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