Provider Demographics
NPI:1538462957
Name:LARSCORP LLC
Entity Type:Organization
Organization Name:LARSCORP LLC
Other - Org Name:ALLIANCE PROSTHETICS AND ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COKER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:541-788-3376
Mailing Address - Street 1:3166 NW COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-5518
Mailing Address - Country:US
Mailing Address - Phone:541-788-3376
Mailing Address - Fax:541-388-0818
Practice Address - Street 1:735 SW 11TH ST STE 103
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2660
Practice Address - Country:US
Practice Address - Phone:541-788-3376
Practice Address - Fax:541-388-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABCCPO#2286335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6484890001Medicare NSC