Organization
ERICKSON MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENT EDWIN ERICKSON M.D. (PRESIDENT, MEMBER, OWNER)
(785) 632-6415
Entity
Organization
Contact information
Practice address
409 LINCOLN AVE, CLAY CENTER, KS 67432-2907
(785) 632-6415
Mailing address
1024 LANE ST, CLAY CENTER, KS 67432-2211
(785) 632-6415
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
IN PROGRESS
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003863
MEDICARE PTAN
KS
05
—
100208950A
—
KS
01
—
18630
MEDICARE
KS
Enumeration date
04/28/2016
Last updated
04/28/2016
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