1124097027 NPI number — MRS. VALERIE A. LARSON M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124097027 NPI number — MRS. VALERIE A. LARSON M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LARSON

Provider First Name:

VALERIE

Provider Middle Name:

A.

Provider Name Prefix Text:

MRS.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

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:

1124097027

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/03/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

P.O. BOX 8

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DELL RAPIDS

Provider Business Mailing Address State Name:

SD

Provider Business Mailing Address Postal Code:

57022-1208

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

605-428-5446

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

111 10TH STREET

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

DELL RAPIDS

Provider Business Practice Location Address State Name:

SD

Provider Business Practice Location Address Postal Code:

57022-1208

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

605-428-5446

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

03/15/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  4884 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1402966 . This is a "AMERICAS PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 4996052 . This is a "WELLMARK BCBS OF SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 0108605 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
• Identifier: 57022A009 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0008142 . This is a "WELLMARK BCBS OF SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 4884 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 55F71LA . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: AH9021028613 . This is a "PREFFERED ONE" identifier . This identifiers is of the category "OTHER".
• Identifier: 5610960 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 5610962 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 063425500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 233740 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".