Basic Information
| Provider Information | |||||||||
| NPI: | 1366895112 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHLAND HEARING CENTERS, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WILLOUGHBY HEARING AID CENTERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26222 RANCH ROAD 12 | ||||||||
| Address2: | |||||||||
| City: | DRIPPING SPRINGS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786204903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128580300 | ||||||||
| FaxNumber: | 5128582714 | ||||||||
| Practice Location | |||||||||
| Address1: | 975 MARKET ST NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973011131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033152055 | ||||||||
| FaxNumber: | 5033152057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2016 | ||||||||
| LastUpdateDate: | 08/05/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WINCHESTER | ||||||||
| AuthorizedOfficialFirstName: | MELONY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR DIRECTOR OF RETAIL OPERATION | ||||||||
| AuthorizedOfficialTelephone: | 5128580300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | N | Suppliers | Hearing Aid Equipment | 261QH0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech |
No ID Information.