1073634614 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 1073634614 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:
JENKINTOWN HEARING CARE
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:
1073634614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6700 WASHINGTON AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-3405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-328-8602
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 YORK RD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JENKINTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19046-2871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-886-2268
Provider Business Practice Location Address Fax Number:
215-886-6016
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAUTH
Authorized Official First Name:
LOUISA
Authorized Official Middle Name:
EIFRIG
Authorized Official Title or Position:
SR MGR CONTRACTING & CREDENTIALING
Authorized Official Telephone Number:
952-947-4983

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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