Provider Demographics
NPI:1073634614
Name:NORTHLAND HEARING CENTERS, INC.
Entity Type:Organization
Organization Name:NORTHLAND HEARING CENTERS, INC.
Other - Org Name:JENKINTOWN HEARING CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR MGR CONTRACTING & CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LOUISA
Authorized Official - Middle Name:EIFRIG
Authorized Official - Last Name:RAUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-947-4983
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 1:500 YORK RD STE 104
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2871
Practice Address - Country:US
Practice Address - Phone:215-886-2268
Practice Address - Fax:215-886-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty