Basic Information
| Provider Information | |||||||||
| NPI: | 1629204342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERICKSON | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHOOK | ||||||||
| OtherFirstName: | GINA | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1111 DUFF AVENUE PO BOX 3014 | ||||||||
| Address2: | MCFARLAND CLINIC PC | ||||||||
| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500103014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152392155 | ||||||||
| FaxNumber: | 5152392155 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 DUFF AVE | ||||||||
| Address2: | MCFARLAND CLINIC PC | ||||||||
| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500105745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152392155 | ||||||||
| FaxNumber: | 5152392155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2009 | ||||||||
| LastUpdateDate: | 12/22/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2011-00831 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5919120 | 05 | NC | MEDICAID |