Provider Demographics
NPI:1447688114
Name:ERICKSON INSURANCE
Entity type:Organization
Organization Name:ERICKSON INSURANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:S
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-999-2290
Mailing Address - Street 1:2206 BROADWAY ST
Mailing Address - Street 2:P O BOX 235
Mailing Address - City:GRANGER
Mailing Address - State:IA
Mailing Address - Zip Code:50109-7716
Mailing Address - Country:US
Mailing Address - Phone:515-999-2290
Mailing Address - Fax:515-999-2628
Practice Address - Street 1:2206 BROADWAY ST
Practice Address - Street 2:235
Practice Address - City:GRANGER
Practice Address - State:IA
Practice Address - Zip Code:50109-7716
Practice Address - Country:US
Practice Address - Phone:515-999-2290
Practice Address - Fax:515-999-2628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA225440251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA225440OtherIOWA INSURANCE LICENSE