Basic Information
Provider Information | |||||||||
NPI: | 1346488384 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NORTHLAND HEARING CENTERS INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | DIGITAL HEARING INSTRUMENTS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10570 SE WASHINGTON ST | ||||||||
Address2: | SUITE 202 | ||||||||
City: | PORTLAND | ||||||||
State: | OR | ||||||||
PostalCode: | 97216 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5032576800 | ||||||||
FaxNumber: | 5032576810 | ||||||||
Practice Location | |||||||||
Address1: | 401 E. 23RD ST | ||||||||
Address2: | SUITE H | ||||||||
City: | PANAMA CITY | ||||||||
State: | FL | ||||||||
PostalCode: | 32405 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8507635100 | ||||||||
FaxNumber: | 8507635100 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/29/2009 | ||||||||
LastUpdateDate: | 01/29/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LONGTAIN | ||||||||
AuthorizedOfficialFirstName: | JEFFREY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 5032576800 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | NORTHLAND HEARING CENTERS INC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |   |
No ID Information.