1316944192 NPI number — DR. LAUREN K LARSON M.D.

Table of content: DR. LAUREN K LARSON M.D. (NPI 1316944192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316944192 NPI number — DR. LAUREN K LARSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARSON
Provider First Name:
LAUREN
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1316944192
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 PASADENA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40503-2925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-278-1316
Provider Business Mailing Address Fax Number:
859-278-9896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2416 REGENCY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503-2954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-278-1316
Provider Business Practice Location Address Fax Number:
859-276-1574
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  36246 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1392787 . This is a "UMWA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611142277 . This is a "TRICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64055080 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000240303 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2125891 . This is a "FIRST HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 23-00145 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 250013955 . This is a "RAILROAD MCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611142277 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611142277R . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 16363600 . This is a "DOL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1200999 . This is a "CHA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50002209 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: K010972 . This is a "CHAMPUS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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