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

General Provider Information

NPI Number	:	1821133059
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 202
City	:	PORTLAND
State	:	OR
Zip	:	97216-2846
Country	:	US
Telephone Number	:	503-257-6800
Fax Number	:	503-257-6810

Provider Business Practice Location Address
First Line	:	401 CRATER LAKE AVE
Second Line	:	SUITE 1
City	:	MEDFORD
State	:	OR
Zip	:	97504-6860
Country	:	US
Telephone Number	:	514-608-9600
Fax Number	:	541-608-9609

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	08/22/2020

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