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
1	237600000X	Audiologist-Hearing Aid Fitter
2	237700000X	Hearing Instrument Specialist
3	231H00000X	Audiologist

General Provider Information

NPI Number	:	1366620452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND HEARING CENTERS, INC.

Provider Business Mailing Address
First Line	:	2510 E SUNSET RD
Second Line	:	UNIT 5-260
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3511
Country	:	US
Telephone Number	:	702-798-0113
Fax Number	:	866-291-5242

Provider Business Practice Location Address
First Line	:	4730 CENTENNIAL BLVD.
Second Line	:	SUITE 104
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3338
Country	:	US
Telephone Number	:	719-598-0586
Fax Number	:	719-598-5968

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEFFREY L. LONGTAIN
Credential	:
Telephone Number	:	702-798-0113

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	06/09/2014

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