Basic Information
Provider Information | |||||||||
NPI: | 1023425865 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NORTHLAND HEARING CENTERS, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ASCENT HEARING & AUDIOLOGY | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8800 SE SUNNYSIDE RD | ||||||||
Address2: | SUITE 300 N | ||||||||
City: | CLACKAMAS | ||||||||
State: | OR | ||||||||
PostalCode: | 970155738 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2812812999 | ||||||||
FaxNumber: | 5126074893 | ||||||||
Practice Location | |||||||||
Address1: | 19415 DEERFIELD AVE | ||||||||
Address2: | SUITE 301-B | ||||||||
City: | LANSDOWNE | ||||||||
State: | VA | ||||||||
PostalCode: | 201768452 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7037239672 | ||||||||
FaxNumber: | 7037240127 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/14/2014 | ||||||||
LastUpdateDate: | 11/18/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WINCHESTER | ||||||||
AuthorizedOfficialFirstName: | MELONY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | SR. DIRECTOR OF RETAIL OPERATIONS | ||||||||
AuthorizedOfficialTelephone: | 5036595115 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |   |
No ID Information.