Provider Demographics
NPI:1083661979
Name:ERICKSON & GILL, P.A.
Entity Type:Organization
Organization Name:ERICKSON & GILL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROXI
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-326-5751
Mailing Address - Street 1:122 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-3045
Mailing Address - Country:US
Mailing Address - Phone:620-326-5751
Mailing Address - Fax:620-326-7915
Practice Address - Street 1:122 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-3045
Practice Address - Country:US
Practice Address - Phone:620-326-5751
Practice Address - Fax:620-326-7915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4087559201Medicaid
KS110776OtherBC/BS OF KS