1043589740 NPI number — NORTHLAND HEARING CENTERS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043589740 NPI number — NORTHLAND HEARING CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHLAND HEARING CENTERS, 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:
Provider Other Organization Name Type Code:
6
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:
1043589740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8800 SE SUNNYSIDE ROAD
Provider Second Line Business Mailing Address:
SUITE 300-N
Provider Business Mailing Address City Name:
CLACKAMAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-659-5115
Provider Business Mailing Address Fax Number:
503-659-5968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 9TH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-425-8242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2011

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 602634408 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 602634408 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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