| |
205 7th St W Park Rapids MN 56470-1545 | |
(218) 732-7760 | |
(218) 732-7334 |
Full Name | |
---|---|
Speciality | Internal Medicine |
Location | 205 7th St W, Park Rapids, Minnesota |
Authorized Official Name and Position | Vern E Erickson (OWNER) |
Authorized Official Contact | 2187327760 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
3920 13th Ave E Suite 6 Hibbing MN 55746-3675 Ph: (218) 263-7540 | 205 7th St W Park Rapids MN 56470-1545 Ph: (218) 732-7760 |
NPI Number | 1528070513 |
---|---|
Provider Enumeration Date | 08/11/2006 |
Last Update Date | 06/13/2008 |
Medicare PECOS PAC ID | 0446296669 |
---|---|
Medicare Enrollment ID | O20050628001060 |
Identifier | Type | State | Issuer |
---|---|---|---|
1528070513 | NPI | - | NPPES |
120354100 | Medicaid | MN | |
82065ER | Other | MN | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Vern E Erickson |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1760595979 PECOS PAC ID: 1557329059 Enrollment ID: I20041230000311 |
Provider Name | Jessica Wirth |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1851774905 PECOS PAC ID: 6901112069 Enrollment ID: I20150903001708 |
Enlightenment Psychiatry Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1011 1st St E Ste 5, Park Rapids, MN 56470 Phone: 320-321-9599 Fax: 877-962-3624 | |