1104829027 NPI number — DR. CYRUS C ERICKSON III M.D.

Table of content: DR. CYRUS C ERICKSON III M.D. (NPI 1104829027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104829027 NPI number — DR. CYRUS C ERICKSON III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERICKSON
Provider First Name:
CYRUS
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104829027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 58326
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205-8326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-771-3033
Provider Business Mailing Address Fax Number:
615-771-0398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1909 MALLORY LN STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-2843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-771-3033
Provider Business Practice Location Address Fax Number:
615-771-3029
Provider Enumeration Date:
05/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  39029 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: 39029 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)