Provider Demographics
NPI:1659598217
Name:JAMES L LARSEN
Entity Type:Organization
Organization Name:JAMES L LARSEN
Other - Org Name:TEAM INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-770-4400
Mailing Address - Street 1:1255 E 3900 S
Mailing Address - Street 2:STE 105
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1365
Mailing Address - Country:US
Mailing Address - Phone:801-293-3001
Mailing Address - Fax:801-293-7157
Practice Address - Street 1:1255 E 3900 S
Practice Address - Street 2:STE 105
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1365
Practice Address - Country:US
Practice Address - Phone:801-293-3001
Practice Address - Fax:801-293-7157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336H0001X, 3336L0003X, 3336S0011X
UT508143336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4611011OtherNCPDP PROVIDER IDENTIFICATION NUMBER