1144416447 NPI number — ELIZABETH A LARSON INC

Table of content: (NPI 1144416447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144416447 NPI number — ELIZABETH A LARSON INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIZABETH A LARSON INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144416447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6810 S LYNCREST AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57108-2515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-274-1119
Provider Business Mailing Address Fax Number:
605-271-9983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6810 S LYNCREST AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57108-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-274-1119
Provider Business Practice Location Address Fax Number:
605-271-9983
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
605-274-1119

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  SD424 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102709 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4905421 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 455505000 . This is a "MAGELLON BEHAVIORAL HEALT" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4996486 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6551970 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9982 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 22188 . This is a "SANFORD HEALTH" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 7305 . This is a "AVERA HEALTH PLANS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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