Provider Demographics
NPI:1043770423
Name:NORTHLAND HEARING CENTERS, INC.
Entity Type:Organization
Organization Name:NORTHLAND HEARING CENTERS, INC.
Other - Org Name:NORTHLAND HEARING CENTERS, INC. DBA HEARING LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:LAYTART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-915-6248
Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:800-328-8602
Mailing Address - Fax:
Practice Address - Street 1:10316 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4702
Practice Address - Country:US
Practice Address - Phone:708-952-0921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech