Healthcare Provider Details

I. General information

NPI: 1184826612
Provider Name (Legal Business Name): LARCORP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7042 STATE RD BB
CEDAR HILL MO
63016
US

IV. Provider business mailing address

PO BOX 419 7042 STATE ROAD BB
CEDAR HILL MO
63016-0419
US

V. Phone/Fax

Practice location:
  • Phone: 636-274-3800
  • Fax: 636-285-4401
Mailing address:
  • Phone: 636-274-3800
  • Fax: 636-285-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. AUGUST W LARSON JR.
Title or Position: C.E.O.
Credential: P.D., R.PH.
Phone: 636-274-3800