Healthcare Provider Details

I. General information

NPI: 1225368079
Provider Name (Legal Business Name): LARSON ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 W 13TH ST N STE 2
WICHITA KS
67212-2982
US

IV. Provider business mailing address

7230 W 13TH ST N STE 2
WICHITA KS
67212-2982
US

V. Phone/Fax

Practice location:
  • Phone: 316-264-8870
  • Fax: 316-264-2681
Mailing address:
  • Phone: 316-264-8870
  • Fax: 316-264-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. LONNIE EDWARD LARSON
Title or Position: OWNER
Credential:
Phone: 316-264-8870