1578990164 NPI number — NORTHLAND HEARING CENTERS, INC.

Table of content: (NPI 1578990164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578990164 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:
1578990164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2510 E SUNSET RD
Provider Second Line Business Mailing Address:
UNIT 5-260
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89120-3511
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:
2100 W. NEW HAVEN AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32904-3864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-674-1605
Provider Business Practice Location Address Fax Number:
321-674-1606
Provider Enumeration Date:
09/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LONGTAIN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-798-0113

Provider Taxonomy Codes

  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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