Provider Demographics
NPI:1285674200
Name:NORTHLAND US LLC
Entity Type:Organization
Organization Name:NORTHLAND US LLC
Other - Org Name:FAMILY CARE HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-486-8734
Mailing Address - Street 1:1404 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2230
Mailing Address - Country:US
Mailing Address - Phone:618-351-7179
Mailing Address - Fax:618-519-9306
Practice Address - Street 1:1404 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2230
Practice Address - Country:US
Practice Address - Phone:618-351-7179
Practice Address - Fax:618-519-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2788237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2832016OtherBLUE CROSS BLUE SHIELD IL