| Matthew G Larson Pc | |
|
24 S 600 E Ste 6 Salt Lake City UT 84102-4201 | |
| (801) 521-0699 | |
| (801) 521-0688 |
| Full Name | Matthew G Larson Pc |
|---|---|
| Speciality | Social Worker |
| Location | 24 S 600 E Ste 6, Salt Lake City, Utah |
| Authorized Official Name and Position | Matthew G Larson (OWNER) |
| Authorized Official Contact | 8015210699 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Matthew G Larson Pc Po Box 1221 Salt Lake City UT 84101-4201 Ph: (801) 521-0699 | Matthew G Larson Pc 24 S 600 E Ste 6 Salt Lake City UT 84102-4201 Ph: (801) 521-0699 |
| NPI Number | 1093984031 |
|---|---|
| Provider Enumeration Date | 02/25/2008 |
| Last Update Date | 02/25/2008 |
| Medicare PECOS PAC ID | 5193622850 |
|---|---|
| Medicare Enrollment ID | O20031218001015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093984031 | NPI | - | NPPES |
| 528330442001 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 03609393501 (Utah) | Primary |
| Provider Name | Matthew G Larson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326002437 PECOS PAC ID: 6901703669 Enrollment ID: I20031219000076 |
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