# LARSEN ANESTHESIA PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598146888
- **Authorized official:** DR. NICHOLAS LARSEN MD (PROVIDER/OWNER)
- **Authorized official phone:** (307) 638-0300

## Contact information

- **Practice address:** 3584 W 9000 S, WEST JORDAN, UT 84088-5710
- **Practice address phone:** (307) 638-0300
- **Practice address fax:** (307) 638-0394
- **Mailing address:** PO BOX 20188, CHEYENNE, WY 82003-7004
- **Mailing address phone:** (307) 638-0300
- **Mailing address fax:** (307) 638-0394

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 76505701204 | UT | Yes |

## Other

- **Enumeration date:** 06/12/2015
- **Last updated:** 06/12/2015