Provider Demographics
NPI:1669654331
Name:ERICKSON'S INC
Entity type:Organization
Organization Name:ERICKSON'S INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-747-6148
Mailing Address - Street 1:421 W RIVERSIDE AVE STE 770
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0402
Mailing Address - Country:US
Mailing Address - Phone:509-747-6148
Mailing Address - Fax:509-638-6705
Practice Address - Street 1:421 W RIVERSIDE AVE STE 770
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0402
Practice Address - Country:US
Practice Address - Phone:509-747-6148
Practice Address - Fax:509-638-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA328043554332B00000X, 335E00000X
WAOS 00000010156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003137000Medicaid
MT566943Medicaid
WA9028838Medicaid
OR153267Medicaid
WA0189910001Medicare NSC