Provider Demographics
NPI:1164509154
Name:ERICKSON HOME MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:ERICKSON HOME MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-823-2106
Mailing Address - Street 1:8 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-1565
Mailing Address - Country:US
Mailing Address - Phone:715-823-2106
Mailing Address - Fax:715-823-1322
Practice Address - Street 1:8 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929
Practice Address - Country:US
Practice Address - Phone:715-823-2106
Practice Address - Fax:715-823-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1164509154OtherNPI
WI41566800Medicaid
WI1164509154OtherNPI