Provider Demographics
NPI:1619124534
Name:NORTHLAND HEARING SERVICES, INC.
Entity Type:Organization
Organization Name:NORTHLAND HEARING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, HEARING AID SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:907-451-4327
Mailing Address - Street 1:29 COLLEGE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-1739
Mailing Address - Country:US
Mailing Address - Phone:907-451-4327
Mailing Address - Fax:907-451-4325
Practice Address - Street 1:29 COLLEGE RD STE 6
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-1739
Practice Address - Country:US
Practice Address - Phone:907-451-4327
Practice Address - Fax:907-451-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK56332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment