=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942409586
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHLAND HEARING CENTERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2007
-----------------------------------------------------
Last Update Date | 07/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3628 W 12TH ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16505-3503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-835-1470
-----------------------------------------------------
Fax | 814-833-8446
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10570 SE WASHINGTON ST STE 202
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97216-2846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-257-6800
-----------------------------------------------------
Fax | 503-257-6810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP FINANCE
-----------------------------------------------------
Name | SCOTT NELSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 952-828-9120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------