Provider Demographics
NPI:1891033346
Name:ERICKSON AUTO TRIM, INC
Entity Type:Organization
Organization Name:ERICKSON AUTO TRIM, INC
Other - Org Name:ERICKSON MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-731-7910
Mailing Address - Street 1:644 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1018
Mailing Address - Country:US
Mailing Address - Phone:920-731-7910
Mailing Address - Fax:
Practice Address - Street 1:644 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1018
Practice Address - Country:US
Practice Address - Phone:920-731-7910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment