Larson, Amy S

Larson, Amy S is an individual health care provider with primary practice located at 834 N Seminary St Suite 304, Galesburg IL 61401-2852. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Larson, Amy S can be contacted via phone (309) 342-2144.

Contact Information

Primary practice address
834 N Seminary St Suite 304 Galesburg IL 61401-2852
Phone: (309) 342-2144
Fax: (309) 342-5104
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 036106772 Illinois

Profile Details

NPI number 1356442172
LBN Legal business name Larson, Amy S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 26th, 2006
Last updated Feb 17th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356442172 NPPES
Illinois MEDICAID 036106772
Illinois Other 4815127
Illinois Other 7860434
Illinois Other 11053882
Illinois Other 364271985-28

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