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General NPI Number Information
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NPI Number | 1780968602
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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 | 10/11/2011
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 6700 WASHINGTON AVE S
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-3405
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Country | US
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Telephone | 952-947-4700
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Fax | 952-828-6946
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Provider Business Mailing Address
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Address Line | 1001 E SUNSET RD UNIT 96595
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City | LAS VEGAS
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State | NV
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Zip | 89193-1246
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Country | US
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Telephone | 702-798-0113
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Fax | 866-291-5242
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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 | 702-798-0113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number |
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License Number State |
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