1770835589 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 1770835589 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:
1770835589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 E. SUNSET ROAD.
Provider Second Line Business Mailing Address:
UNIT 96595
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89193-1246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-798-0113
Provider Business Mailing Address Fax Number:
866-291-5242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10470 W CHEYENNE AVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89129-8732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-240-2059
Provider Business Practice Location Address Fax Number:
702-240-2065
Provider Enumeration Date:
10/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDS
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
800-328-8602

Provider Taxonomy Codes

  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332S00000X , with the licence number: G64-04040 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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