MEDICARE: PEARL DISTRICT HEARING TECH

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	332B00000X	Durable Medical Equipment & Medical Supplies		OR

General Provider Information

NPI Number	:	1407072820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARL DISTRICT HEARING TECH

Provider Business Mailing Address
First Line	:	1849 NW KEARNEY ST STE 200
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-1453
Country	:	US
Telephone Number	:	503-224-1371
Fax Number	:	503-553-3668

Provider Business Practice Location Address
First Line	:	1849 NW KEARNEY ST STE 200
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-1453
Country	:	US
Telephone Number	:	503-224-1371
Fax Number	:	503-553-3668

Authorized Official
Title or Position	:	OWNER
Name	:	DR. R STERLING HODGSON
Credential	:	MD
Telephone Number	:	503-224-1371

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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Directions to “PEARL DISTRICT HEARING TECH ” Practice Location

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