Provider Demographics
NPI:1114217940
Name:LARKINS NEUROSURGERY PA
Entity Type:Organization
Organization Name:LARKINS NEUROSURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:VAUGHN
Authorized Official - Last Name:LARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-412-8044
Mailing Address - Street 1:889 GRAND AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3008
Mailing Address - Country:US
Mailing Address - Phone:612-412-8044
Mailing Address - Fax:651-292-4171
Practice Address - Street 1:889 GRAND AVE
Practice Address - Street 2:STE 102
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3008
Practice Address - Country:US
Practice Address - Phone:612-412-8044
Practice Address - Fax:651-292-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC05896Medicare PIN