Organization
NORTHLAND US LLC
Active
Other names
Family Care Hearing
Organization subpart
No
Provider details
NPI number
Authorized official
MARK HOLTZ (GENERAL MANAGER)
(952) 486-8734
Entity
Organization
Contact information
Practice address
100 S MARKET ST, SPARTA, IL 62286-2062
(618) 443-6233
(618) 443-5834
Mailing address
100 S MARKET ST, SPARTA, IL 62286-2062
(618) 443-6233
(618) 443-5834
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
2637
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2832016
BLUE CROSS BLUE SHIELD IL
IL
Enumeration date
06/07/2006
Last updated
08/22/2020
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