Provider Demographics
NPI:1104279959
Name:NORTHWEST HEARING CENTERS-LOMBARD, LLC
Entity type:Organization
Organization Name:NORTHWEST HEARING CENTERS-LOMBARD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-987-0326
Mailing Address - Street 1:501 POND GATE DR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9208
Mailing Address - Country:US
Mailing Address - Phone:847-987-0326
Mailing Address - Fax:
Practice Address - Street 1:412 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-352-3351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41487060332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment