1366892978 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 1366892978 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:
1366892978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26222 RANCH ROAD 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DRIPPING SPRINGS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78620-4903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-858-0300
Provider Business Mailing Address Fax Number:
512-858-2714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
833 SW 11TH AVE STE 619
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97205-2120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-223-5272
Provider Business Practice Location Address Fax Number:
877-228-9548
Provider Enumeration Date:
06/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WINCHESTER
Authorized Official First Name:
MELONY
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR OF RETAIL OPERATION
Authorized Official Telephone Number:
512-858-0300

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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