Provider Demographics
NPI:1407072820
Name:PEARL DISTRICT HEARING TECH
Entity Type:Organization
Organization Name:PEARL DISTRICT HEARING TECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:STERLING
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-224-1371
Mailing Address - Street 1:1849 NW KEARNEY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1453
Mailing Address - Country:US
Mailing Address - Phone:503-224-1371
Mailing Address - Fax:503-553-3668
Practice Address - Street 1:1849 NW KEARNEY ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1453
Practice Address - Country:US
Practice Address - Phone:503-224-1371
Practice Address - Fax:503-553-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies