Provider Demographics
NPI:1114164514
Name:PORTLAND HEARING SPECIALISTS, INC.
Entity Type:Organization
Organization Name:PORTLAND HEARING SPECIALISTS, INC.
Other - Org Name:PORTLAND HEARING AID SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:HAS
Authorized Official - Phone:503-261-9309
Mailing Address - Street 1:8505 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-1139
Mailing Address - Country:US
Mailing Address - Phone:503-261-9309
Mailing Address - Fax:503-261-9311
Practice Address - Street 1:8505 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-1139
Practice Address - Country:US
Practice Address - Phone:503-261-9309
Practice Address - Fax:503-261-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-339566237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty