Healthcare Provider Details

I. General information

NPI: 1427250331
Provider Name (Legal Business Name): GENE K. ERICKSON BC-HIS, ACA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 S HIGLEY RD STE 119
MESA AZ
85206-3450
US

IV. Provider business mailing address

1423 S HIGLEY RD STE 119
MESA AZ
85206-3450
US

V. Phone/Fax

Practice location:
  • Phone: 480-495-0626
  • Fax: 480-985-7198
Mailing address:
  • Phone: 480-495-0626
  • Fax: 480-985-7198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1532
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD1532
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: