1598945859 NPI number — CS LARSON OD & ASSOCIATES PC

Table of content: (NPI 1598945859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598945859 NPI number — CS LARSON OD & ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CS LARSON OD & ASSOCIATES PC
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:
1598945859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1390 HIGHWAY F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNESVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65583-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-774-2040
Provider Business Mailing Address Fax Number:
573-774-6152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1390 HIGHWAY F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65583-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-774-2040
Provider Business Practice Location Address Fax Number:
573-774-6152
Provider Enumeration Date:
11/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
573-774-2040

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  T03398 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1598945859 . This is a "TRICARE FOR LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "GOVERNMENT EMPLOYEES HEALTH ASSOCIATION, INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "PHYSICIANS MUTUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "CONTINENTAL LIFE INSURANCE COMPANY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "BLUE CROOS BLUE SHIELD OF MINNESOTA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "CARPTENTERS' HEALTH & WELFARE TRUST FUND OF ST. LOUIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "LA FIREMEN'S RELIEF ASSOC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "LIFE INVESTORS INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 916309 . This is a "ADVANTRA FREEDOM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "UNITED HEATHCARE INSURANCE COMPANY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "BLUE SHIELD OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "MUTUAL OF OMAHA COMPANIES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "COMBINED INSURANCE COMPANY OF AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1598945859 . This is a "AMERICAN REPUBLIC INSURANCE COMPANY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "EPOCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7102000MO65583 . This is a "BLUE CROSS AND BLUE SHIELD OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000414171 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "AMERICAN PIONEER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "BANKERS LIFE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com