1316227168 NPI number — NORTHLAND HEARING CENTER, INC

Table of content: (NPI 1316227168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316227168 NPI number — NORTHLAND HEARING CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHLAND HEARING CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEAR FOR YOU
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316227168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8800 SE SUNNYSIDE RD
Provider Second Line Business Mailing Address:
300-N
Provider Business Mailing Address City Name:
CLACKAMAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97015-5738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-659-5115
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
870 HOOSICK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180-6624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-283-3955
Provider Business Practice Location Address Fax Number:
518-435-0020
Provider Enumeration Date:
08/25/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LONGTAIN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-659-5115

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  00800 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)