Basic Information
| Provider Information | |||||||||
| NPI: | 1932436565 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHLAND HEARING CENTERS, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WHITE'S ADVANCED HEARING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10570 SE WASHINGTON ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972162846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032576800 | ||||||||
| FaxNumber: | 5032570288 | ||||||||
| Practice Location | |||||||||
| Address1: | 2632 W 2ND ST | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689014606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024631083 | ||||||||
| FaxNumber: | 4024631083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2009 | ||||||||
| LastUpdateDate: | 11/03/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LONGTAIN | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5032576800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 578 | NE | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.