Provider Demographics
NPI:1104177757
Name:ERLAND INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:ERLAND INTERNAL MEDICINE, PC
Other - Org Name:ERLAND INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KERILYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-602-7999
Mailing Address - Street 1:3667 N LOCUST GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5924
Mailing Address - Country:US
Mailing Address - Phone:208-939-9090
Mailing Address - Fax:208-939-9911
Practice Address - Street 1:3667 N LOCUST GROVE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5924
Practice Address - Country:US
Practice Address - Phone:208-939-9911
Practice Address - Fax:208-939-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-23
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6886261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDG24175Medicare UPIN