Provider Demographics
NPI:1457683468
Name:NORTHLAND HEARING CENTERS, INC.
Entity Type:Organization
Organization Name:NORTHLAND HEARING CENTERS, INC.
Other - Org Name:HEARING CENTERS OF SOUTHWEST FL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDREGUERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-947-4602
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 1:4137 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5110
Practice Address - Country:US
Practice Address - Phone:941-482-6005
Practice Address - Fax:941-485-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2019-05-30
Deactivation Date:2014-04-28
Deactivation Code:
Reactivation Date:2014-04-29
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty