| Organization Name: | ERICKSON MEDICAL CLINIC, LLC |
| NPI Number: | 1689029464 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENT EDWIN ERICKSON (PRESIDENT, MEMBER, OWNER) |
| Mailing Address: | 409 Lincoln Ave Clay Center |
| State: | KS US |
| Postal Code: | 674322907 |
| Phone Number: | 7856326415 |
| Fax Number: | |
| NPI Enumeration Date: | 04/28/2016 |
| NPI Last Update Date: | 04/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | IN PROGRESS |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |