MEDICARE: ERICKSON'S INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	328043554	WA
2	156FX1700X	Ocularist	OS 00000010	WA
3	335E00000X	Prosthetic/Orthotic Supplier	328043554	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669654331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERICKSON'S INC

Provider Business Mailing Address
First Line	:	421 W RIVERSIDE AVE STE 770
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0402
Country	:	US
Telephone Number	:	509-747-6148
Fax Number	:	509-638-6705

Provider Business Practice Location Address
First Line	:	421 W RIVERSIDE AVE STE 770
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0402
Country	:	US
Telephone Number	:	509-747-6148
Fax Number	:	509-638-6705

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MONICA D ERICKSON
Credential	:
Telephone Number	:	509-747-6148

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	04/13/2021

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Directions to “ERICKSON'S INC ” Practice Location

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