1902867047 NPI number — ERICKSON & GILL, P.A.

Table of content: (NPI 1902867047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902867047 NPI number — ERICKSON & GILL, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERICKSON & GILL, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ANTHONY DENTAL
Provider Other Organization Name Type Code:
3
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:
1902867047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 N ANTHONY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANTHONY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67003-2007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-842-3844
Provider Business Mailing Address Fax Number:
620-842-4139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 N ANTHONY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTHONY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67003-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-842-3844
Provider Business Practice Location Address Fax Number:
620-842-4139
Provider Enumeration Date:
03/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GILL
Authorized Official First Name:
CARISSA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
620-842-3844

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1301234 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 420738 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 103017 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".