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	:	1790092690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND HEARING CENTERS INC

Provider Business Mailing Address
First Line	:	10570 SE WASHINGTON ST
Second Line	:	SUITE 210
City	:	PORTLAND
State	:	OR
Zip	:	97216-2846
Country	:	US
Telephone Number	:	503-257-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	640 W PRIEN LAKE RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8316
Country	:	US
Telephone Number	:	337-474-0923
Fax Number	:

Authorized Official
Title or Position	:	VP FINANCE
Name	:	SCOTT NELSON
Credential	:
Telephone Number	:	952-828-9120

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	09/13/2010

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