MEDICARE: NORTHLAND HEARING CENTERS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332S00000X	Hearing Aid Equipment

General Provider Information

NPI Number	:	1033669528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND HEARING CENTERS, INC

Provider Business Mailing Address
First Line	:	6425 FLYING CLOUD DR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3305
Country	:	US
Telephone Number	:	281-286-2999
Fax Number	:

Provider Business Practice Location Address
First Line	:	7820 TERREY PINE CT
Second Line	:	SUITE 110
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-1104
Country	:	US
Telephone Number	:	952-594-8358
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR OF RETAIL OPERATION
Name	:	MELONY WINCHESTER
Credential	:
Telephone Number	:	281-286-2999

Provider Enumeration Date	:	10/07/2016
Last Update Date	:	10/07/2016

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