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	237600000X	Audiologist-Hearing Aid Fitter
2	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1750795233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND HEARING CENTERS, INC.

Provider Business Mailing Address
First Line	:	6700 WASHINGTON AVE S
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2234 N WAHSATCH AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6940
Country	:	US
Telephone Number	:	719-632-2376
Fax Number	:	719-633-2327

Authorized Official
Title or Position	:	BILLING SPECIALIST
Name	:	MEE VANG
Credential	:
Telephone Number	:	952-828-9127

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	05/08/2024

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