Provider Demographics
NPI:1164626222
Name:EASY RISERS INC
Entity Type:Organization
Organization Name:EASY RISERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-844-5751
Mailing Address - Street 1:11344 DAKOTAH BEACH RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-8205
Mailing Address - Country:US
Mailing Address - Phone:218-844-5751
Mailing Address - Fax:218-844-5752
Practice Address - Street 1:11344 DAKOTAH BEACH RD
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-8205
Practice Address - Country:US
Practice Address - Phone:218-844-5751
Practice Address - Fax:218-844-5752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4451360001Medicare NSC