| Erickson Medical Clinic | |
|
205 7th St W Park Rapids MN 56470-1545 | |
| (218) 732-7760 | |
| (218) 732-7334 |
| Full Name | Erickson Medical Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 205 7th St W, Park Rapids, Minnesota |
| Authorized Official Name and Position | Vern E Erickson (OWNER) |
| Authorized Official Contact | 2187327760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Erickson Medical Clinic 3920 13th Ave E Suite 6 Hibbing MN 55746-3675 Ph: (218) 263-7540 | Erickson Medical Clinic 205 7th St W Park Rapids MN 56470-1545 Ph: (218) 732-7760 |
| NPI Number | 1528070513 |
|---|---|
| Provider Enumeration Date | 08/11/2006 |
| Last Update Date | 06/13/2008 |
| Medicare PECOS PAC ID | 0446296669 |
|---|---|
| Medicare Enrollment ID | O20050628001060 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528070513 | NPI | - | NPPES |
| 120354100 | Medicaid | MN | |
| 82065ER | Other | MN | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Vern E Erickson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760595979 PECOS PAC ID: 1557329059 Enrollment ID: I20041230000311 |
| Provider Name | Jessica Wirth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851774905 PECOS PAC ID: 6901112069 Enrollment ID: I20150903001708 |
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