1104100759 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 1104100759 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:
1104100759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2011
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:
STE 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:
17115 SE 270TH PL
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-5400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-659-5115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LONGTAIN
Authorized Official First Name:
JEFFERY
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: "Y" .

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





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