Active NPI
P. Rene Larson
- Private Vehicle
- Lead, SD
National Provider Identifier
1649921776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Private Vehicle
- License
- 9B1243
- Practice address
- 301 Chicago Ave
Lead, SD 57754-1007 - Phone
- (605) 641-3467
- NPI assigned
- Jan 11, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Private Vehicle | 347C00000X | 9B1243 | SD | Primary |
Addresses
Primary practice location
301 Chicago Ave
Lead, SD 57754-1007
Mailing address
301 Chicago Ave
Lead, SD 57754-1007
Phone (605) 641-3467
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9B1243 | SD | MD | Private Vehicle |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641859200000",
"number": "1649921776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 CHICAGO AVE",
"city": "LEAD",
"state": "SD",
"postal_code": "577541007",
"telephone_number": "605-641-3467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 CHICAGO AVE",
"city": "LEAD",
"state": "SD",
"postal_code": "577541007",
"telephone_number": "605-641-3467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "P.",
"middle_name": "RENE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-11",
"last_updated": "2022-01-11",
"certification_date": "2021-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "347C00000X",
"taxonomy_group": "",
"desc": "Private Vehicle",
"state": "SD",
"license": "9B1243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lead, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.